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THE
SEATS and CAUSES
O F
DISEASES
INVESTIGATED BY ANATOMY;
IN FIVE. BOOKS,
CONTAINING
A Great Variety. of DISSECTIONS, with Remarks.
TO WHICH ARE ADDED
Very Accurate and Copious INDEXES of the
.Principal Things and Names therein contained.
Translated from the Latin of
JOHN BAPTIST MORGAGNI,
Chief Profeflbr of Anatomy, and Prefident of the Univerfity at Padua,
By BENJAMIN ALEXANDER, M. D.
IN THREE VOLUMES.
VOL. II.
LONDON,
Printed for A. Millar; and T. Cadell, his Succefl^r, in the Strand;
and Johnson and Payne, in Pater-nofter Row. >^«S^TY OF M>Ta^^
^ My,
MDCCLXIX.
oD
LIBRARY
Found*! 1313
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Arfcsrcu.
T O
DR R U S S E L L.
S I R,
IT gives me a fecret, and a fincere, pleafure, that I have
the honour of addreiling myfelf to You on this occa-
fion. 1 have been long wifliing for an opportunity of
difcharging, in fome meafure, the debt of gratitude and
refpect which I owe to Your Character. And I might have
waited flill longer, for fuch an opportunity, had not the
occafion before me, which I gladly embrace, prefented
itfelf.
Various are the views in which Dr. Russel ltands
intitkd to my efteem, I mean as the Preceptor, the Phyfi-
cian, and the Friend. In each of thefe departments have
his Humanity and Capacity been confpicuous. And to
Him, in each of thefe Characters, do I (land almoft equally
indebted. From His examples, as a Preceptor, I long had
the pleafure and advantage of receiving the moft excellent
maxims in the Practice of Medicine, and of learning an
a 2 accurate
iv DEDICATION.
accurate Attention to Difeafes. And that practical Skill,
which I had often been witnefs to in others, I have been
happy enough to experience in myfelf. Nor is it without
a peculiar pleafure that I exprefs my gratitude on this head,
as well becaufe it is the only trieute I can be allowed
to beftow, as becaufe the kind offices of Friendfhip went
hand-in-hand with the endeavours of the Phyfician.
The Public, then, Sir, will at once be a judge of the
propriety of this Addrefs. The Public, which is always
grateful itfelf,~ and refpects that principle in individuals,
will fee how juft and indifpenfable it is to dedicate to You
a part of the Labours of that Life, which You have been
thus inftru mental in preferving. That You may live hap-
pily and long, in the exertion of that Medical Skill, for
the benefit of your fellow-creatures and that Your friends
may, confequently, be long indulged with that conde-
fcenfion, and readinefs to oblige, which I have fo often
experienced at Your hands are the earned wifhes of
Your fincere Friend,
And refpedful humble Servant,
BENJ. ALEXANDER.
[ V ]
CONTENTS
O F T H E
SECOND VOLUME.
BOOK III. Of Disorders of the Belly.
Letter
XXVIII. r\ F preternatural Hunger ; of flawing to Death ; and of
injured Deglutition.
XXIX. Of the Singultus; of chewing the Cud in Men; and of Pain
in the Stomach.
XXX. Of Vomiting.
XXXI. Of intejlinal Profluvia, without Blood, or Bloody.
XXXII. Of Co/livenefs j and of the Piles.
XXXIII. Of the Prolapfus of the Intefline Reclum.
XXXIV. Of the Pain of the Intefines.
XXXV. Of the fame.
XXXVI. Of Tumor and Pain in the Hypochondria.
XXXVII. Of the Jaundice j and of bilious Calculi.
XXXVIII. Of the Hydrops Af cites, Tympanites; the Dropfy of the Peri-
tonaum j and others whico we call mcijlid Dropfies.
c XXXIX.
vi CONTENTS.
Letter
XXXIX. Of the remaining internal Tumours of the Belly.
XL. Of Pain in the Loins.
XLI. Of the Supprefjion of Urine.
XLII. Of the Difficulty of Making-water ; the Ardor Urince ; and
other Dif orders in which the Urine is concerned.
XLIII. Of Hernia.
XLIV. Of the Gonorrhea.
XLV. Of the Defcent of the Uterus-, and of the Afcent thereof as
the Women call it.
XLVI. Of the Impediments to Vcnery ; and of Sterility in both Sexes.
XLVII. Of the Diforders of the Menflrual Flux ; and of the Fluor
Midiebris.
XL VIII. Of falfe Pregnancy; of Abortion j and of unfuccefiful De-
livery.
E R R A T U M.
Tage 3. Line 1. for Letter XXVII. read XXVIII.
THE
SEATS and CAUSES
O F
DISEASES
INVESTIGATED BY ANATOMY.
B O O K the T H I R D,
Which treats of Disorders of the Belly.
Vol. IB,
B
V.' 18 JJ
LETTER the TWENTY-SEVENTH,
Contains Tome Obfervations on preternatural Hunger, and
upon Death from the fame Caufe ; and afterwards
• treats of injur'd Deglutition..
i. A"\F all the four books, into which the Sepulchretum Anatomicum is
I J divided, the third is by far the longeft, inafmuch as it compre-
X^^ hends the diforders of all parts whatever, that relate particu-
larly to the belly, and not only in the male body, but in the female alfo.
For which reafon, I fhall now take the more pains to ftudy brevity, as far as
I am able •, which I am under a neceflity of doing, if I would, at length,
ever put a finiQiing hand to this work, that I have undertaken for you.
And there feems to me, to be the molt room for doing this, in thofe feve-
ral fubjects, which are fpoken of feparately, in the four firft fections, " Lofs
" of appetite, preternatural hunger, morbid thirft, and injurrd deglutition."
For if you except the laft, there is not one dhTection, which has been per-
form'd by Valfalva, or by me, that relates, in particular, to thefe arguments.
And left you mould be furpriz'd at this, only confider, how feldom it hap-
pens, that any perfon dies, whom a loft appetite for food, or too great
hunger, or thirft has confum'd, without fome violent diforder being joined
with it, or being the confequence of it. Wherefore, if where I have treated
of this violent diforder, or fhall treat of it, you find that thefe diforders are,
at the fame time, taken notice of, what occafion is there, that thofe things,
which are necefiarily faid, or to be faid, in other places, fhould be needlefsly
repeated here ? Turn over, I befeech you, thefe three firft fections of the
Sepulchretum. You will fee that a languid appetite, or a deficiency there-
of, was generally joined with great injuries of the vifcera, that is with great
diforders ; and that great thirft was generally join'd with fevers, with in-
flammations, and with dropfies. For which reafon Bonetus tells us, that
fome of the fame obfervations are again produc'd by him, in other places,,
and even fome of thofe, in regard to which he makes no fuch declaration,
are reproduc'd in other places. But this is lefs fur prizing, than that the fame
obfervations fhould be again repeated, in one and the fame fection. For in.
lihe firft fection, the third, and fourth, obfervations are no others than thofe
B 2 which.
4 Book III. Of Difeafes of the Belly.
which are produced in article the feventh, under the ninth obfcrvation, and
article the nrft, under the tenth obfcrvation. Nor in the third fection, in
like manner, are the third, and fourth, obfervations, any other than what
are again given, under the fifth obfervation, article the feventh and third,
as thofe alio are one and the fame, that are found under obfervation the
feventh, article the fecond, and in the additamenta, under obfervation the
fourth, article the firft, befides others which you perhaps will remark.
2. Thefe things, however, I do not fay of the fecond feclion. Yet one
thing I fay, that this exceffive hunger was, alfo, join'd together with forn^
confiderable difeafe, as either the various fymptoms, here and there, in the
living patients, or the diforders in the vifcera of the bodies after death, de-
monftrate. Befides, if you except fome certain conformations, that are
very rare, and thofe fuch as were imprefs'd on the very ftamina of the body,
as for inflance, the pylorus being deficient, or wider, and, at the fame time,
much fhorter than is natural, and the tube of the inteftine, being lefs dif-
torted into folds, and circles, to which I wonder thefe two other caufes,
that are fo well known, one of which was found by Ruyfch to be adven-
titious (a ), and the other by Dionis to be congenial (£), are not added ; I
fay, if you except thefe, in mod: other obfervations there will be reafon to
doubt, whether a true, or a falfe, caufe of unufual hunger be advanced ;
as when that caufe is fought after in the fpleen, as if it difcharg'd fomething
into the ftomach (c), and when it is fuppofed to confift in the enlarg'd ftate
of the ftomach (d), which you will fay, was rather the effect of too great
a quantity of food being taken in, than the caufe, juft as in the firft feclion
(<?), you would fuppofe, that the very fmall capacity of the contracted
ftomach, in a man who had eaten nothing for a long time, was the effect of
taking in no food for fo long a time, and by no means the caufe why the
patient could eat nothing. And in regard to the fpleen, and the magnitude
of the ftomach, you will doubt fo much the more, by and by, when you
have read the appendix after the feventh obfervation, and the tenth ob-
fervation itfelf. But will you believe the unufual magnitude of the liver (f),
to have been the caufe of exceffive hunger, either becaufe it cherilhed the
ftomach more by its warmth, or becaufe it feparated a greater quantity of
bile? or rather an effect, becaufe from an encreas'd quantity of nourishment,
this foft vifcus had been much encreas'd in its fize, juft as it happens in
geefe that are full-fed ? and if you think thus, in regard to the liver, will
you not judge nearly the fame of the pancreas alfo (g) ? as if truly, becaufe
it was furnifh'd with two ducts, which went to the inteftines in diftinct
places Tan appearance that has been, more than once, found in other bodies,
and even in thofe that had not been troubled with a morbid hunger) the
vifcus miift, for that reafon, fecrete a much greater quantity of juice, which
circumftance v/as not to be argued from the number of the ducts, as thefe
might be fmall in proportion, but entirely from the more enlarg'd ftate of
the vifcus, which was, in other refpects, found, if its ftate was really en-
(rt) Obf. anat. chir. 74. (<r) Obf. 5.
(6) Anat. de l'homme demonftr. 2. (f) Obf. 2.
(<■) Obf. a. & feq. {£) Obf. 13.
U\ Obf. i. ScS.
larcAl.
Letter XXVII. Article j
largM. Finally, to omit other things, fhould ic ha I I.. id, that the
" pica had anion from the ftomach being almoft in a fphacelated ftate?"
certainly not j tor this mortal diipofition of the ftomach, as it was in a wo-
man, who was juft at the point of death, could nor, without doubt, have
exifted, at the time " when flic was fond of eating cinders and afhe.s."
3. But do you approve of nothing, in this whole fection, you will fay ?
yes: I do approve of 'many things, notwithstanding I could wifn, there had
been a better choice, in fome tilings, and in others, a more nice judgment.
There are, alio, ftill other cafes, that I cannot admit without fome hefitation .
and others on the contrary, that I am even able to confirm. You fee, for
inftance, what is laid in the ninth obfervation, of fome lice being de-
vour'd by an icteric boy, fo that they grew in tire ilomach, to " a mon-
rtrous magnitude, and to a very confiderable multitude," and brought on " an
" infatiable hunger, by confuming the aliment" taken in. Do thefc crea-
tures then, like to feed upon the fame kind of nourifhment as men ? and do
they thrive very well therefrom ? or is the ftomach a very proper place for
them to live in, fo that they mail neither be overwhelm'd with the liquors
taken in, nor carried away to the interlines, together with the food in which
they are fo greedily entangled ; and is it even a proper place for them to
propagate in ? In fhort, if they had really liv'd there, would they not ra-
ther have quickly brought on an intolerable erofion, in a vifcus of this de-
licate nature, and a fenfe of erofion, rather than of hunger ? and yet no
erofion is mention'd, as having been feen in the dead body. Wherefore,
for more than one reafon, the obfervation that is adjoin'd in the fcholium,
and is given, in another place, under this title (&), " A pain of the ftomach,
from bladders full of lice being affix'd to it," may feem fomewhat lefs in-
credible : although I am much inclin'd to fufpect, that in both of the cafes,
fome little bodies, or if you will have it fo, fome little animals, were feen,
which in fome meafure refembled lice, efpecially as it is clear, that he who.
relates the fecond, was not himfelf prefent ; and he who related the firft,
has not exprefly faid that he was himfelf prefent •, and neither of them, whe-
ther the lice were at that time ftill alive, in order to fliow us from the mo-
tion, at lead, that they were animalcules. But as I obferv'd, after I had
written thefe things, that the cafe feemM credible, to more than one of my
learned friends •, I would, for that reafon, fo much the more have you re-
member, that I do not fay thefe things, as a perfon who abiblutely denies
the truth of the fads, but rather as one who doubts thereof. On the other
hand, when in the appendix, which is fubjoinM to the icholia of the obfer-
vation, the queftion is of worms in the human body, caufing exceiTive
hunger, by their peculiar magnitude, or number, there is no reafon for
hefitation thereon. For thefe creatures live-in their proper places, and feed
on their natural provifion : and if their place, and provifion, be not in pro-
portion to their magnitude, or at leaft to their multitude, it is evident that
the animal, in which thefe worms are, being defrauded of its nourifhment,
muft be often troubled, with an incredible hunger, and often even with an
incredible third. For both of thefe circumftances have not onlv been, fre-
{b) L; hoc 3< f. 6. obf. 33.
quently.
Book III. Of Difeafes of the Belly.
quently, obferv'd by others, but by me alfo, and particularly in that young
whelp, which I accurately directed, and in which, though it died- after being
troubled with thefe fymptoms, I could no where find any morbid appear-
ance befides a great number of worms, as I have written in the letter, which
was formerly publifli'd by our Valiifneri (z). So likewile, when the obfer-
vations of Bontius are pointed out (k) " of exceffive hunger, and canine
appetite," as it is call'd, being the confequence of infardtions in the me-
fentery, they bring to my mind what Albertini had formerly related ta
me, that he, in fome bodies, who had labour'd under this kind of diforder,
and particularly in a boy, who was hungry to fuch a degree, as to be fre-
quently feiz'd with fwoonings from that very caufe, had found the glands,
that lie in the belly, to be tartarizated, as the common phrafe is, ib as to
turn the edge of the knife by their hardneis. But whether there was an
abdominal flux in thefe perfons, and of what kind it was, when the frefh-
iupplies of chyle were continually intercepted by the mefentery, or whether
there was none at all j for in Bontius (/) you will read that there was a
lientery ; I do not certainly remember.
4. I am alfo pleas'd with thofe diffe&ions, that are produe'd in the laft
place (m), of two men who were kill'd, by a long abftinence from meat,
and drink, but fhould have been Hill more pleas'd, if, as they fliow " than
** the veins, and arteries, were furprizingly emptied, and that from- the vena
*' cava, fcarcely two or three fpoonfuls of blood flow'd out, and from the
" aorta, none at all -," fo, in like manner, they had fhown other things, that
are worthy of obfervation, as for inftance, the ages of thefe men, their confti-
tution, habit, ftrength, and the exact number of the days of their abftinence>
the fymptoms which preceded their death, the Hate of their vifcera, and other
things of this kind. Which accuracy would have been extremely ufeful, in
the firft of thefe men particularly, as he was, " in other refpects, of a found
** and healthy body," when he took the refolution of killing himfelf with
hunger. For thofe who, in confequence of difeafe, or the torture of it, are
brought to fuch a ftate, as to be able to take no nourifhment, can teach us
nothing certain, either living, or dead, as you are, without doubt, entirely
ignorant, how many days this difeafe, itfelf, might, perhaps, have taken away
from life, and what unufual appearances, the privation of nourifhment had,
of itielf, brought upon the vifcera. So in the works of the celebrated
Peyerus, I mean the ion, we have the directions of a man, and a woman (n)>
who were ftarv'd to death with hunger ; but in both of them, we read of
morbid appearances, of the internal parts, and of fuch a kind, that when we
acknowledge thefe to have related to diforders, we do not very greatly wifh
for thofe other informations, which I mention'd juft now. On the contrary,
moft of thefe circumitances are accurately taken notice of by the very ex-
cellent Fantonus (0), in a woman who obftinately refus'd taking food for
fifty days, when fhe died. But as fhe did, however, take a little twice, and
which is of ftill more confequence, made ufe of water by way of drink,
although " in very lmall quantity," fhe is by no means to be compar'd wi;h
(!) Confideraz. int. alia generaz. d^' venni. (m) Obf. iS. § 1. & z.
(k) Obf. 12. (n) Obf. anat. 1. & 7.
(I) Vid. Sepulchr. 1. 3. f. 10. obf. 1. (0) Diflert. anat. renov. 1.
3 th«
Letter XXVII. Article 5, 6. 7
the man, of whom I made mention in the firft place. For how much the
drinking of water, may contribute, by diminifhing the fcarcity of the hu-
mours, and tempering their acrimony, which are the two things moil in-
jurious to hungry perlpns, to lengthen out their lives, is proved by the
experiments of Redi (p)y who keeping many capons without any food,
obferv'd that of thole to which he, alfo, denied drink, not one of them liv'd
beyond the ninth day, whereas that, to which he gave as much water, as he
would have, which he drank, very greedily, and frequently, for the firft fixteen
days, lived more than twenty days. Nor indeed do I believe, although
Pomponius Atticus (q) ended his life, together with his very violent difeafe,
within the fifth day of his abftinence from food, it would firft have hap-
pen'd, " that the fever left him all at once," and the difeafe have begun to
be more mild, " if he had abftain'd" from drink alfo, " for the fpace of
*' two days," as he had " from food." However, whether that fhort alle-
viation of Atticus, is, perhaps, to be explain'd, from the forty-feventlx
aphorifm of the fecond fection, of Hippocrates, as if the pus had then ceas'd
to be prepar'd, which afterwards " burft out by the loins," or whether it is
rather to be attributed to his abftinence from food, fince Redi (r) affirms
that it is incredible, how beautiful the vifcera of thole animals are found to
be, that have died of hunger, you are quite at your own liberty to determine.
I will confirm to you another maxim of Redi, in regard to thole things which
I have above thought deficient in obfervations of this kind, by a certain
experiment of Valfalva's. Much, fays Redi (s), do the age, and ftrength,
of animals contribute to make them bear up the longer under hunger. And
the following is the experiment of Valfalva, which is written with the
accuracy, and care, that we require.
5. A dog was taken away from his mother's dugs, a little after being
whelp'd, and kept from all kind of nourifhment. On the third day of his
hunger, he began to be attack'd with convulfive motions in his whole bodv,
fometimes more violent, fometimes more mild. He died on the fourth day.
The belly being open'd, the gall-bladder was found to be very full of bile.
The thorax being open'd, the lungs, in the right fide, were ting'd with a
very black oblong fpot : the auricles of the heart were much dilated by
coagulated blood : of which the ventricles were alfo full. And in all the fan-
guiferous vefiels likewife, but particularly in the veins, whatever blood there
was, had become coagulated, fo that it was no where found to be fluid. At
length, the cranium being cut through, the cerebrum was found to be Kbit,
and flaccid, and not very well diftinguifh'd into two fubftances, fo that the
cortical part could be known from the medullary. Both the tympana of the
ears, being full of a pellucid jelly, had the little bones exactly well-form'd
indeed, but, even at that time, preferving their membranous foftneis.
6. The convulfive motions, which had preceded death, are, in fome
meafure, like thofe, that Valfalva had obferv'd, before the death of that
woman (/), who had abftain'd fix days from meat, and drink. But thofe
(pj Oflervaz. int. agli animali viventi, (r) Oflerv. cit.
&c. (s) J bid,
(q) Vid. ejus vit. apud Corn. Nep. (t) Epill. 17. n. 25.
appearance*
8 Book III. Of Difeafes of the Belly.
appearances that were in the whelp after death, are moft of them p
rather to the foetus, than to the animal, who has died of hunger, yet k \
of them are common to both, as the quantity of bile, by reaion of the g
bladder not being comprefs'd by the ftomach, or the nearer! interline, .
of which were of courfe flaccid. But, alfo, whatever bile flows down . i
the liver to the interlines, fo much the more readily appears therein, ac ft
is not hid by a mixture with the food that is taken in. Nor does rca: > 1
only confirm this, but obfervation alio, as well in almoft all thole animal**
which Redi had kill'd by hunger, as we know from the teftimony of CaJ-
defi (k), as in men who were destroyed by abftinence, which the joint
obfervations of Peyerus (x), Fantonus (y), and Haller (z) demonfu-ate..
It is alfo (hewn by reafon, (as by long abftinence, from all kind of meat and
drink, the humours of the body become very acrid, and tend, to putre-
faction) how eafily it may happen, that the bodies of. thofe who die of
hunger, mail fmell very ftrongly, as is aflerted by a very celebrated writer,.
of the bodies of men, but particularly of dogs : which mark added to others,
would certainly be ufeful, not only to thofe who defire to know, whether
fome men were carried off more by hunger, or by difeafe ; but alio, fome times,.
to thofe, who I fee doubt whether the dogs on which experiments have
been made, have died of thefe experiments, or of hunger. But I will now leave
thefe confiderations, to thofe who (hall hereafter make the experiments, and
pais over other things alfo, to infift upon that which I promifed you. How.
long the dogs lived, which Redi (a) had thus kept, from all kind of meat
and drink, you will underftand from hence, that fome of them reached to-
thirty-four days, others to thirty-fix, and that a little whelp feemed likely to
live for many more days, if he had not thrown himfelf headlong from a.
very high window. But although this was in fact a fmall whelp, he never-
thelefs was not juft born, as that was which, according to the obfervation
of Valfalva, could not live over the fourth day. Indeed, that there may be
wonderful varieties in thefe things, I the more readily confefs, the more I
attend to the great number of different inftances of long abflinence, which
are both learnedly producM, and accurately confider'd, by that very learned
man Beccarius (b.) Neverthelefs I mould fuppofe, that whatsis deliver'd
down by Hippocrates (c) pretty well agrees with truth, if you except fome
very rare conflitutions of bodies, and circumflances of cafes, I mean that
41 young perfons" bear fading " with lefs eafe, and children lead of all,'*
which, on the contrary, they bear more eafily, who " are middle-ag'd, and
" old men the mod eafily of all," unlefs, perhaps, they are quke decrepid
with age, as Celfus wifely (d) interprets Hippocrates, by giving his opinion
in the following manner : " men of a middle age bear abdinence very eafily,,
" but young men not lo well, and children, and men very far advane'd in
" years, cannot bear it at all ; — but that perfon is moft of all under ne-
(u) Oflervaz. int. alle Tartarughe. (a) O/Tervaz. cit. fupra ad n. 4.
(x) Obf. 7. cit. fupra ad n. 4. (b) Vid. de Bonon. Sc. Acad. t. 2. p. I,
(y) Dill', ibid. cit. inter Medica.
(z) AdBoerh. Prarlccl. §98. not. 2. & (c) Seel 2. aph. 13.
opuic. Pathol, obf. J4. (d) D.e Medic. 1. 1. c, 3.
* ceflity
Letter XXVIII. Article 7. 9
" ceffity of taking food, whole growth is moft advancing :M which Hippo-
crates, alio, had exprefly taught, in the next aphorifm (e).
7. And the opinion of Hippocrates would be furprizingly well confirm'.!
by one itory, if this were really, as Cardan (/), and Zambeccarius (%), have
haltily fuppos'd, a hiftorv, and not a poetical figment of Dante (b)y of tlie
count Hugolini, and. his four ions, who were llarved to death with hunger
(which one fact is undoubted), fo that all of them lived fome days, but the
boy, of three years, died on the fourth day, and the other children, who
were fomewhat older, or almoft young men, on the fifth, or the fixth day,
and latt of all, the father, as he was of a middle age, or at lead only jult
entering upon old age, died on the eighth day : all which circumitances
were, without doubt, imagin'd by the poet himfelf, in conformity to the
aphorifm of Hippocrates, the author being at that time very learned, or at
leaft in conformity to probability, as the poet himfelf, fufficiently fhews in
that place, though thefe worthy men have not attended to it, where he in-
troduces the fpirit of Hugolini relating thefe things to him, which, as he
exprefly fays, " he could not have been informed of " by any other means,
inafmuch as they had happen'd in the dark recefles of a high tower, the keys
of which were thrown into the river by the enemy, immediately after they
had been fhut up therein.
If therefore you happen to want a number of hiflories, to prove the
feveral parts of the aphorifm of Hippocrates, as they are explained
by Celfus, I will take notice of fome from the Roman hiilory, which
come into my mind, as I am writing. I have faid above (i), that Pom-
ponius Atticus, being fick, died on the fifth day of his abftaining
from food. But Sextius Bacillus, as you have it in Cadar's Commen-
taries (k)y although he was fo far fick, " as to have been without food for
" five days," was fo far from death as to take up arms and repel the enemy,,
inafmuch as he was at fuch a flourifhing time of life, as, not long before,
to have perform'd the office of firft centurion, to the legionary foldiers ; but
Atticus had compleated his feventy-feventh year : fo we muft not be fur-
priz'd, that Suetonius (I), when he fpoke of Tiberius having " abftain'd
" from food, for the fpace of four days," did not only not add what injury
he receiv'd therefrom ; but even afferted, that Tiberius " immediately went
M down to Oftia" j for Tiberius was at that time of a middle age, and a firm
conilitution.
To thefe, you will, yourfelf, add examples of younger perfons : nor
will you eafily find, I believe, when you come to children, and infants,
any who have born fadings of this kind, in fuch a manner. Nor indeed
would I have you objedl to me, from the obfervation of Fernelius (m)t the
inftance of a foetus who feems, as a really memorable example, to have
born a want of nourifhment for the fpace of two months. For notwithftand-
ing the mother, who " in the opinion of all thofe that attended her, had
*' fwallowed down no meat, nor drink, for the whole two months," at
length, in the latter end of the fever, of which fhe died, " brought forth a
{e) 14. (i) N. 4.
(f) Com. in cit. Aph. 13. (*) De Bell. Gall. 1. 6. c. 38.
(g) Experim. circa diverfa e viventib. exfefta. {I) De duodecim Cxfarib. 1. 3. c. 10.
(I) Infem. cant. 33. '. {m) Pathol. 1. 6. c. 1. in fin,
Vol. II. C " child
8 Book III. Of Difeafes of the Belly.
" child that Hie left furviving-," yet as often as ever flie got down food, or
drink, quite to the lower part of the cefophagus, which {he immediately
brought back, and threw up, it is to be fuppos'd, that iome portion of the
ingeib., which were going backwards and forwards, had always entered the
mouths of the abforbent vefiels, in the mouth, the fauces, and the cefopha-
gus, and that by thefe means, this woman was preferv'd for fo long a time,
nearly in the fame manner as another gravid woman mentioned by Hilda-
nus (n), who was kept alive, for the fpace of fix weeks together, with her
foetus, by nourifhing glyfters alone. And, indeed, it is not abfurd to fup-
pofe, that the tubercle with which the mouth of the ftomach was fhut up,
as appeared in her body after death, had not been fo large while Ihe was
living, as quite to obftruct that orifice, unlefs, perhaps, in the latter part
of her life ; for diforders of this kind are continually increafing, and confe-
quently extend themfelves to fuch a degree, as to reach thofe parts, that
they did not, fometime before, reach.
8. This obfervation of Fernelius brings to my mind the fourth fection of
the Sepulchretum, in which even this very obfervation is (o), of which
fection I made fuch mention in the beginning (p), as to difcover, that I was
not wanting in obfervations relative thereto, or in other words, to impeded
deglutition. And certainly, I fhould not be at all deficient, if I thought
proper to imitate what is done, even in this fection. For you will fee, that
the fourth obfervation in it, differs from the feventeenth, only by being re-
lated in fomewhat fewer words : and you will wonder ftill more, at the fame
thing taking place m the nineteenth, if compar'd with that to which it is
immediately iubjoin'd, I mean the eighteenth. And in the additamenta
themfelves, does not one part of the fecond obfervation repeat, in fo many
•words, what had been already given, with fufficient fullnefs, in the fame
fection, in a part of the fcholium to the eighth obfervation ? I however fharl
not repeat here, even thofe which I have produced in other letters, from
Valfalva's obfervation, or my own. But whatever of this kind remains,
I will give you here ; thofe others I ihall but juft make references to. And
two hiftories do remain from the papers of Valfalva. The fitft of thefe is
as follows.
9. A man of fifty years of age, began to complain of his deglutition be-
ing impeded. The impediment was by degrees encreas'd : his voice'f was
loll : he had a considerable pain in fwallowing : a portion of the food re-
mained in his fauces, which fometimes return'd after that, by degrees, into
his mouth, feemingly corrupted : his body became emaciated : nothing pre-
ternatural was to be feen externally ; only the left internal maxillary gland
was perceived to be indurated. He died fuddenly fuffbeated as it were.
The gland juft now mention'd, as being indurated, had at the fide of it, a
matter like the white of an egg. And many tumours were feen in the
pharynx, and at the upper part of the larynx, which were of a cancerous
nature.
10. A young man, likewife, who died almofl in the fame manner, after
very fimilar fymptoms of difeafe, difcover'd tumours of the fame nature,
particularly at the upper part of the larynx, and the neighbouring fides
(n) Cent. 4, obf. 30, (c) Obf. 21.. (/) N. 1,
q£
Letter XXVIII. Articles n, 12, 13. 11
of the pharynx. Rut the tumours, in ibmc places, were already ulcerated :
and an ulcer had perforated the epiglottis itfelf.
11. As to what relates to the fudden death of both thefe perfons, you
may from hence confirm what I have before faid (q) Vallalva had told
me, I mean that he had twice feen a death of this kind, from a violent dif-
order of the larynx, at which time he perhaps had thefe two cafes in his
eye. The fame was alio oblerv'd by me, in a virgin, of whom I took no-
tice in the fame place, and perhaps, alio, in a very excellent finger, who
was troubled with a very manifeft ulcer in the fauces, which caus'd a great
difficulty in fwallowing. But as it was not pofiible to determine, in the
living body, to what parts this ulcer extended itfelf, nor yet permitted to
examine it after death, I therefore did not lay down the thing as certain, and
well enquir'd into, efpecially as ulcers of that kind, fometimes do not reach
to thole parts you would fuppofe them to reach, and. reacli to others that you
would not have fuppofed. And this will be clearly fhown, by the cafe of a
man, who was match' d away by the fame kind of death : which cafe, al-
though I have partly hinted at it in the Epiftolas Anatomies (r), and partly
in a letter which I have before fent to you (s), yet I have no where given at
large, but purpofely defer'd it to the prefent occafion, as relating to impeded
deglutition.
12. There was a man in whom, as he fwallow'd, part of what he drank
return'd by his noftrils. The bony palate of the man was quite found; but
the palatum molle, together with the uvula, had been confum'd by an ulcer
that was not recent, and which, as far as could be diftinguifh'd by the eye,
was already brought to a cicatrix •, but where the eye could not reach, it
continued even then, as the matter, which was thrown up by fpitting, de-
monftrated. Thisjoin'dto a cough, that was fometimes troublefome, and
other fymptoms of a fimilar kind, although flight and ambiguous, created a
fufpicion of an ulcer extending itfelf downwards. And this fufpicion was
encreas'd, by the patient dying fuddenly, as if fuffbeated.
Neverihelefs, the inferior part of the pharynx, and the larynx which lies
within it, and the canal of the afpera arteria, that lies below the larynx, were
altogether uninjur'd : although the left lobe of the lungs, at the upper part,
which was hard to the touch, was found, when I cut into it, to be exceedingly
corrupted, to a very confiderable extent. But the ulcer had extended itlrlf
to the higher parts of the pharynx, and to the pofterior foramina of the
noftrils, and there continued. As to the other parts, when the belly was
open'd, I found the liver, the inteftines in fome places, and the internal
mufcles of the abdomen, livid, as if from foregoing inflammation, and
fmelling very ftrongly.
13. Where, and at what time, I differed this body, you will find in
thofe epiftles, to which I juft now referr'd (/), and in the fame place, and
alfo in the twenty-fecond of thefe letters to you («), you will fee what I hint-
ed in regard to the origin, and caufes of that diforder, of the- lungs. But
for what relates to the caufes, and manner, in which deglutition was injur'd,
in this man, or in the two diffecled by Valfalva, that I have given you the
(?) Epift. 22. n. 25. (/) N. u.
(>■) Epift. 9. 11.9. Sc 10. (u) N. 26.
(;) Epift. 19. n. 50.
C 2 hiftories
i 2 Book III. Of Difeafes of the Belly.
hiftories of, they are fo evident to any one, not ignorant of the motions of
the whole pharynx, and larynx, that are neceflary for the performance of
deglutition, that there is not the leaft occafion to explain them. To thefe,
belong feventeen obfervations, in this fourth fection of the Sepulchretum,
which are in two appendixes, that are fubjoin'd to the twentieth obfervation.
And although when I have, frequently, found, as I have already faid, the
cartilages of the larynx become bony, in old men (x), the epiglottis was
never yet found to be bony by me, 1 do not, however, doubt but it may
fometimes, become lefs flexible, and yielding : which is a circumftance that
ieems to be more prejudicial to the fwallowing of food, than of drink. For
the liquors that we drink, when they have reach'd as far as the epiglottis,
flow down on one fide, and on the other, where there is a kind of fulcus
at the fides of the larynx, and flip down to the lower part of the larynx :
nor does it then happen that they enter the larynx, unlefs they either flow
back, in too great a quantity, from the fulci, or thefe fulci, by inflamma-
tion, and a tumid ftate of the parts, are deflroy'd, or a kind of convulfion
excited, by irritation, or any of the mufcles, that, by reafon of being af-
fected With a paralyfis, is unequal to its office, difturb the eafy flowing
down of the liquors : the latter of which I have obferv'd, in a woman of
princely rank, after an attack of the epileptic kind, and the former, in a
noble Count, whofe very troublefome diforder I have already defcrib'd to>
you (jy), and which was, in part, fimilar to a convulfive, but very iTiort,
angina.
I would not here have you fuppofe, that the confederation of the epi-
glottis is fuperfluous, when the queftion is of impeded deglutition, be-
caufe Targioni (z) lit on the body of a man, in whom, although the epi-
glottis was entirely deficient, perhaps from having been formerly deftroy'd
by an ulcer, the power of fpeaking, and of fwallowing, without any diffi-
culty, were not wanting, or at leaft, in the laft acute diforder of which he
died. For although the arytenoid mufcles, which were in him much thicker,
and ftronger, than they in general are •, might have been able to fhut up the
glottis fo exactly, as by way of an unufual inftance in the human body, to
fupply the office of the epiglottises other parts have fupplied the office of the-
uvula, fometimes, and fometimes of the tongue, when originally deficient,
or from difeafe (a), or whether accurate obfervations, and examinations,
mighty while he was living, have fhown other things ; we ought certainly to>
take care, in consideration of what happens naturally in the greater part of
mankind, and not of what happens by way of prodigy in any one, not to
pun into fuch abfurdities, as to fuppofe the epiglottis almoft ufelefs, as it
were, in deglutition.
I am not ignorant,, that there are, at this time, celebrated men, to.
whom it feems that deglutition may be explained fo differently, from
the manner in which others explain it, that if you are of their opinion,
you will not want that explication which I hinted at juft now, of the
difference there is betwixt fluids, and folids, in pafTing from the mouth into
(x) Adverf. i. 2. 23.. (a) Ephem. n. c. Dec. 3. A. 9. obf. 212..&
(y) Epilt. 14. n. 37. Slevogt. cliff, de Gurgul. {.. 61. 6$.
fzj Prima. Raccolia. di oiler., mcd. verfb-
iL fine..
the
Letter XXVIII. Article 14. 13
the fauces. I confefs it is not, at prefent, cither a proper place, or time, to
confider the whole of their opinion, as the importance of it requires, yet I
will, at leaft, venture to lay, that there is in this opinion, more than one
thing, which I can by no means admit.
Nor does itefcape me, that there is a remark made by Paul Barbette, that is
alio to be read lure in the Sepulchretum (£), which by no means agrees with
that explication 1 have given you above. But if there was, at the fame time,
" an abolition of fpecch," there mult have been other diforders, befides a
rigidity of the epiglottis, " not fufficiently fhutting up " the larynx, in the
paifage of liquors, or •* an induration" of it, to which one circumftance Pau-
lus attributes all the fymptoms. But what part was affected with difeafe, be-
iides the epiglottis, in another certain obfervation, in which I read that the de-
glutition " both of folids, and fluids," was impeded, 1 fhould perhaps be
able to conjecture, if I underftood what appearances were found in the body
after death. And the following appearance is faid to be found ; " the epi-
" glottis, by means of a catarrhous fpafm, was fo drawn up, towards the
" orifice o£ the cefophagus, that the orifice of the afpera arteria remained
" quite open, and neither fluids, nor folids, could be taken down, for fear
" of fu (location." But I cannot pofiibly conceive, how the orifice of the
larynx could be quite open, while the epiglottis was drawn up in fuch a
manner, as this orifice fhould have been, in that cafe, quite cover'd. And
in this manner I fhould be ready to fuppofe it was written by the author,
and ill-copied, which is eafily done by fubftituting aperlum inflead of
fipertttm, only that the patient would then have been under a neceflity of
thinking how to breathe merely, inflead of thinking how to fwallow.
14. But, to return to the obfervation of Paulus given in the Sepulchretum ;
as to the attempt in the fcholium, which is immediately added, to explain that
impediment of deglutition, by " a convulfion of the mufculi hyoidasi, be-
*' cauie the larynx is then drawn upwards •," the explanation ought to have
been more ftrict, and exprefs, efpecially as the mufcles, which may be fig-
nified by that name, are many in number, and fome of them perform of-
fices directly oppofite to each other. Nor yet is it to be doubted, that not only
the os hyoides, and larynx, but even the parts that belong to them, if they
are by any means confiderably affected, may cauie an impediment to de-
glutition. For you will call to mind, that this had happen'd from the upper
appendages of that bone being luxated, as is related by Valfalva (r), and, in
like manner, from the cartilages of the larynx being luxated, as Boerhaave
(d) writes, from the obfervation of Cowper, the thyroid, I fuppofe, bein ^
remov'd from the cricoid •, for the book, in which Cowper gives you this
cafe, I have not in my pofTefiion ; and whether thofe things which you may
read of, in the acts of the Csfarean academy (e), are referable to the fame
clafs, you will judge ; the method of cure, at leaft, comes pretty near to that
of Valfalva.
But in regard to the convulfion, or paralyfis, of the mufcles, even
of the cefophagus itfelf, it is to very little purpofe to fay any thing, fince
(i) Obf. 6. (d) Pradeft. ad Inftit. §. 806.
(f) De aure hum. c. 2. n. z<s, \e) Torn. 6. obi". c,o.
l examples
14- Book III. Of Difeafes of the Belly.
examples of the former are very often to be met with, in hyfterical pa-
tients, and obiervations of the latter, though more rare indeed, are not
wanting, notwithstanding it is a diieafe, like other paralytic affections, of
much longer continuance, and more obftinate, than the firft, fo that the
patients have, for this realon, either been deftroy'd by hunger, as you may
fee in Willis (/), Helwich (£■), and others, or fometimes by means of ali-
ments being thruft down into the ftomach, by the help of a chirurgical in-
ftrument, have been kept alive, for twelve, or fourteen months, and at
other times, even for fixteen years, the latter of which kind of cafes the fame
author, Willis, has in his Pharmaceut. Ration, (in the firft part indeed, but
in the fecond lection, and in the firft chapter, not as it is faid in the Sepul-
chretum (h), feclion the third, chapter the third), and the former, nature at
length having overcome the diforder, Job Bafterus, in the year 1682, com-
municated to Stalpart (/'), and the fame author, being a lively old man, in
the year 1744, which is a remarkable inftance, communicated it to the
Caefarean academy (k). And Rammazini (/) faw aparalyfis, of a fhorter con-
tinuance than that indeed, overcome, without the intrufion of this inftrumenr,
into the oefophagus, which is a very troublefome operation, as he laved a
female patient without the leaft food, or drink, for threefcore and fix days,
by the means of nourifhing glyfters, a longer, and more ufeful, pradtife of
which, I do not remember ever to have read ; and this is a kind of remedy,
which, as it is always eafy, and always innocent, ought never to be ne-
glected by the phyficians, in every fpecies of impeded deglutition, and not
only in that from a paralyfis of the mufcles.
Moreover, you will, I fuppofe, think with me, that the cafe which you read,
related by the celebrated Heifter, in a certain differtation of John Charles
Spies (ot), is to be refer'd to a kind of flight paralyfis. This cafe is of a noble-
man, and one who was already old, and had, for a long time, been affected in
fuch a manner, that though he could fwallow every thing very well but his laft
bolus, he could not, however, fwallow that, which, for this reafon, frequently
remained in his fauces, from one meal to another, till it was, at length, puln'd
down in the following meal, unlefs it had happen'd to be previoufly thrown up,
by the help of fpitting, or fome flight cough. And I made no doubt but this
circumftance happen'd much in the fame manner, as in men pretty far ad-
vane'd in years, all the urine is expell'd from the bladder, one part urging
another, till it comes to the laft drops, which the weaken'd power of the
mufcles is, now, not able entirely to expel, as they had been us'd to do at
a more flourifhino- time of life. So likewife, in this man the former bo-
luffes were pufh'd forwards by the weight of the following ones, till the
laft being without that afliftance, and not being fufficiently help'd on by
the mufcles of the pharynx, was under a necefllty of remaining, where it
had been already thruft.
15. But as this, and moft of the diforders of which I have hitherto fpo-
ken, related to the pharynx, and the parts that lie neareft to it, fo others
(f) Pharn. rat. p. 1. f. 1. c. 2. (£) Aft. t. 8. obf. 21.
(g) Eph. n. c. cent. i.& 2. obf. 147. (/) Conft. epidem. a. 1691. n. 22.
(b) Seft. hac 4. in addit. obf. 2. in fin. (m) De Dejl. c. 2. n. 9.
(/') Cent. poll. p. 1. obf. 27.
are
Letter XXVIII. Article 15. 15
are alio to be met with, wii ch relate to the cefophagus itfelf, anil the parts
that lie there about. As to convullion, and paralyfis, there is no occafion to
lav any thing more upon theft heads. But there are two other diforders,
which are, in like manner, contrary to each other, that may be the caules of
difficult deglutition, I mean the drynefs of the glands of' the cefophagus («),
and their cedCrrratous ttirgefcency (0). Befides, the gula is fometimes ulcer-
ated : a remaikable inftance of which you have in the Sepulchretum (/>).
And although an ulcer of itfelf, if it be painful, or at leaft if it be large,
and have prominent lips, one of which kind was leen by Brunnerus (q)t whom
you muft turn to on this occafion, impedes the ufe of deglutition ; yet if
there be none of thefe eircumftances, and the ulcer itfelf begins to be in-
clin'd to a healing ftate, or is even already in part healed •, it may frequently
happen, that fome confequences of the ulcer may remain, and obftruct de-
glutition, as a caruncle, callus, narrownefs, or, in fine, coalition, which is
taken notice of by Francifcus Sylvius (r).
And the caruncle at the termination of the gula, feems to have been
formerly hinted at by Galen (j), when he laid " it fometimes hap-
" pens, that even fomething fklhy (fuch as we often fee externally) is
" generated in the ftomach, which either entirely obftrudts the paflage of
" the aliments, or, at leaft, hinders it in fome meafure." And here,
in the Sepulchretum (/), you certainly fee that a caruncle is taken no-
tice of, which aroie from an ulcer of the cefophagus, that was heal'd
up. And notwithstanding all calli, of the gullet, are not to be account-
ed for from ulcers, as, for inftance, where you read in Czelius («), of the
44 beginning, and upper part, of the ftomach, being callous," nor yet
all narrownefs, or contraction, as that which is related in this fection (#), to
have happen'd after an ardent fever, unlefs you will fuppofe, that, in this
cafe, there were aphthae, or internal puftules (j) ; yet where an ulcer has
preceded, or, in part, yet remains, as in a foldier (z), who found great dif-
ficulty in fwallowing, but not the leaft pain, we muft attribute " the coarcla-
" tion, and callofity," of the cefophagus, to the erofion, which was found at
the fame time, being not entirely remov'd, all round. Nor is it to be
doubted, but the fame caufe that brings on contraction, or narrownefs, may
alio produce coalition, under which name, I here underftand, with the
learned Mauchart (a), that coarctation, which leaves no paflage at all, or
fcarcely any. And indeed, the coalition which he faw (£), of a callous
nature, and fcarcely admitting a (lender probe, was not without a purulent
ichor. Neverthelefs, a coalition does fometimes happen, from other caufes
alio (as that perhaps did in fome meafure) many of which I fhall take no-
tice of below (c ), and fome of them relate to tumours generated in the very
coats of the cefophagus, obfervations of which kind are given us in this
(//) Eph. n. c. cent. 1. append, n. 10. obf. («) Morb. chron. 1. 3. c. 2.
162. (*) Obf. 14.
(0) Earund. cent. 5. obf. 59. ubi I.M. Hoff- (y) Vid. aft Hafn. t. 1. obf. 109. & Eph.
man. & Benedict. Sylvaric. citantur. n. c. dec. 2. a. 9. obf. 45.
(p) In addit. ad banc fed. obf. 1. (z) Commerc. litter, a. 1741. hebd. 25.^. I.
(?) Gland. Duoden. c. 10. (a) Diff. de ftruma asfoph. §. 18.22.
(r) Prax. med. 1. 1. c. 5. (I>) §. 11.
[s) De fympt. cauf. 1. 3. C. 2. (r) N. 16-
(.') Obf. 21..
1 ledion
i6 Book III. Of Difeafes of the Belly.
fcction of the Sepulchretum (d), and another, which well deferves reading,
is added by the celebrated Widmann (e). But that lpecies of coalition,
which is brought about by means of a cartilage, merits our attention above
all others, three inftances of which are produc'd in the Sepulchretum (/) :
and to thefe, ycu will particularly add two others, one of which is accurate-
ly defcrib'd by our Vallifneri (g), and the other is moreover iliuftrated in a
very learned differtation, by the celebrated Trillerus (b).
There are fomc very eminent men, to whom, that dilbrder " feems to arife
*' from the drinking of hot water," a cuftom fo frequent in this age, which I
do not altogether deny. But I wonder, nevertheless, as even the ancients or
at lcaft as the Chinefe, who are very tenacious of their cuftoms, have made
ufe of hot liquors, for fo long a time, and do (till ufe them, that there
have not been formerly found, and are not at prefent found, among them,
fuch as labour under an impeded, or injur'd, deglutition •, and it is even
not often, or rather it is fo very feldom, that the ceiophagus is found to be car-
tilaginous amongft us, that I do not remember who has ever met with this ap-
pearance, in Italy, befides Vallifneri, and even he found it in fuch a man,
in fuch a place, and at fuch a time, that it does not feem pofTible to account
for it, from theabule of coffee, or tea: and I do not mention that Trillerus,
in his cafe, had accounted for it from quite an oppofite cauie (/').
Be this as it will, I mention'd coalition by means of a cartilage, becaufe here
alfo I obferve the ceiophagus, if not to be entirely ftop'd up by a cartilage, as
in the obfervation of Stoffelius (£), at lead to be fo far obftrudted in the other
inftances, that only a very fmall foramen remain'd. But what if the carti-
lage did not protuberate outwards ; but left the pafiage open to its natural
fize ? do you think that the faculty of deglutition would be unhurt ? that
very experiene'd phyfician, Viclorius Gornia, comrrunicated to me a dif-
fection made in Germany, of the body of a mod high, and mighty prince,
whofe ceiophagus was externally membranous, but internally cartilaginous,
and towards the ftomach bony, to the extent of an inch. Yet this prince
had not only, for the laft two years of his life, vomited every day at
the interval of two hours after dinner ; but had even never complained of
any uneafinefs, or difficulty, in fwallowing. Does it not follow then,, that
the food, alfo, may be driven on by the ftronger mufcles of the pharynx,
through the gula, when not collaps'd in its parietes, nor (landing in net:i\ of
dilatation, but perpetually kept open by the rigidity of its fides, in the
very fame manner as the blood is propell'd through a bony artery, by the
force of the heart, and the arteries which lie behind it ?
You, therefore, will confider of this, and at the fame time adding the laft
obfervation, to the five I mention'd above, you will again confider with your-
felf, whether it feems proper, to attribute to the abuie of hot water, that dis-
order, which, as is demonstrated by four out of thefe fix examples, did not oc-
cupy the tongue, the fauces, or the upper tract of the gullet, but chiefly the
lower part of this tube. And of the other two, one defcribes the dilbrder, as be-
(d) Obf. 22. \. I. & in addit. obf. ?. {b) De fame lethali ex callofa oris ventric.
(e) Aft. n. c. t. 6. obf. 149. anc;uftia.
(f) Obf. 8. 9. 20. (/) ibid. §. 42.
(g) Operc, t. 3. offerv. 36. (/'•) 2c. hie in Scpulch.
ginning
Letter XXVIII. Article 16. ij
ginning from the region of the clavicles ; fo that there is one, in which the
beginning of the celbphagus is faid to be fhut up by a cartilage, together
with the termination of the pharynx : and for this reaion Stoffelius enquir'J,
which others would not even have thought of, whether we might not make
uie of phai yngotomy, in imitation of the operation that they call laryngo-
tomy, or rather, whether an incifion might not be made into the upper part
of the celbphagus, through which a pipe, carrying in nourifhment, might
be convey'd, by prcfering an uncertain remedy, as he fays, to a certain
death •, but at the fame time, which is to be lamented, a very difficult and
dangerous operation, as all muft readily conceive, who compare the deep fi-
tuation of the upper part of the cefophagus, with that of the afpera arteria,
which lies quite at hand, and is almoft fuperficial, efpecially as it is attended
with fo many mufcles, nerves, and confiderable vefiels.
1 6. And that the parts, lying near to the cefophagus, may impede de-
glutition, in more ways than one, is fhown even by thole obfervations, which,
as I have written them to you in other places, it will be fufficient here to
point out, in purfuance of my promife. For thefe parts can not only be in-
jurious, by making fuch a comprefiion as to obftruct the paflage, in the
manner of that tumefied gland, in a woman of eighty years of age (/), or
of the great artery, when dilated in the trumpeter (m), or as even both of
them together, in a man diflected by Valfalva, when he was a young man
(w) •, but alfo by deterring the patient from fwallowing, fince even when the
paflage is open, thefe parts, being comprefs'd by the aliments that are fwal-
low'd, bring on danger of fufFocation, as the dilated aorta did, in the woman
who was difleded by the fame perfon (o), in the marquis Paulucci (p) and in
Ferrarini phyfician at the court of Modena (q). But to return to the glands
that comprefs the cefophagus, what the thymus, when tumefied, can do to
produce this effect, is not only fhown in this feclion of the Sepulchretum,
(r), but alfo confirm'd by the obfervation of Verdriefius (s). And there
are other glands, which, by their diftention, prefling immediately upon the
gullet, without any thing being interpos'd, do, in like manner, produce
narrownefs, and coalition, and in particular thofe that are call'd glandule
dorfales : and this you will learn from the fame feftion (/), and ftill more
from fome obfervations of a great number of diflectors, which are pointed
out by me, in the Epiflolae Anatomic^ («), and which you may join to the
Sepulchretum, carelefs of the hefitation of Mauchart (#), when he wonder'd
that thofe, at leaft, which are taken from Laurentius, and Diemerbroeck, for
the others he readily admitted of, were not to be found in his copies of thofe
authors works, becaufe he would not have wonder'd, had he obferv'd,
that as Laurentius, and Diemerbroeck, had both of them revis'd their writ-
ings, the firft fince the year 1595, and the laft fince the year 1679, and had
made additions to them at the fame time, it was proper for me, not to make
(I) Epifl:. 15. n. 15. (r) Obf. 10.
(«) Epilt. 18. n. 22. (j) Epii. n. c. cent. 8. obf. 90.
(«) Epift. 17. n. 19. (/) Obf. 16.
(e) Ibid. n. 25. («) Epi'L 9. n. 46.
(/>) Ibid. n. 26. (*) DifTert. fupra ad. n. 15. cit. §. 6.
(g) Epiit. 18. n. 17.
Vol. II. D ufe
1 8 Book III. Of Difeafes of the Belly.
ufe of thofe former, but of the latter, editions, in which, if you enquire,
thofe very words are to be found, that I have quoted from each.
Mauchart however, as he is a man no lefs cautious, than humane, on fuch
an occafion, has at lead faid, that which cannot be denied, I mean, that the
words are not to be found in his copies of thefe authors. But another gentle-
man who is, in other refpects, very learned, having in his difputation on the
fiftula lachrymalis, happen'd to light, among other things that he took from
me, on a paflage of Ariftotle, from the fecond book ~De generatione animalium
C. V. which was quoted by me, en pajfant, in the fixth of the Adverfaria (_y)>
and having copied the words, as they are given by me, has pretty confi-
dently pronoune'd, " that thefe words were not really to be found, in the
" place quoted," not once calling to mind, that fome might, perhaps, make
ufe of copies, which were differently divided from his. And as with
Sylvefter Maurus, I follow'd not only " the common divifion, of the works
" of Ariftotle, into books, and chapters, but alfo the common tranflation," or
rather, the very words of Ariftotle himfelf, I hop'd, indeed, that if any
mould choofe to collate the paflage with the original, from whence it was
taken, they would look for it according to the common divifion, or, if
they happen'd to be without this, that they would readily find the paflage,
in their editions of that fecond book, in which the queftions of the proofs
of fecundity are treated of, and in that paffage would find the fame words,
or at leaft, the fame fentence.
And I fay the fentence, left you mould, perhaps, be put to a ftand by
that one word colorent ; for that Ariftotle meant this, is not only demon-
ftrated by reafon, but affirmed by phyficians, and amongft them by Niphus
(z), who had explain'd the fame book, and paflage, of Ariftotle, a hun-
dred and twenty years before the paraphrafe of Maurus (a).
And indeed, when I examined the word xpw/jiaT/£coo"i, which Ariftotle has
made ufe of, in the Greek text, as it was proper 1 fhould, and which
certainly fignifies colorent, tingant, inficiant, that is " colour, ftain, or dye ;"
I made not the leaft doubt, but it ought to be thus render'd, and confe-
quently, fuppos'd it to be owing to an error of the copifts, or printers, that
in the tranflation perficiant is foolifhly inferted, in the place of inficiant. And
this remark, I was willing to throw in, on this occafion, left thofe who read
hefitations, or cenfures, of this kind in differtations that have been much
commended, and have gone through more than one impreffion, fhould fup-
pofe, in confequence of my perpetual filence, and ftill more from the autho-
rity of thofe by whom both thefe differtations were written, that thefe
ftridlures are juft.
For as to a fomebody, whofe name I would not fo much as enquire in-
to, but only into this one thing, whether he could fay, which has been
denied, that he had receiv'd any provocation from me ; as to fome-
body, I fay, whether more fool, or knave, I know not, having, as I was
told in former years, babbled out fomething rafhly, and injurioufly, in op-
pofition to the opinion of the greateft men, and the moft proper judges, in
regard to my method of writing, formerly, upon fome books, which was ne-
(y) Animad. 65. (a) Ejufdem 1. 2. c. 5. art. 3. ad. n. 11.
(z) Expof. in 1. 2. Ariftot. de generat. animal.
4 ceflary,
Letter XXVIII. Article 17. 19
ceffary, and ufeful ; I fhall never be fo weak as to fuppofe, that wife men
expedt me to make any reply : I will therefore leave him, and fuch as he,
if there are any fuch befides, to their own dreams, with the ridiculous in-
terpretations of which I hear he is delighted. But if men who deferve an-
fwers, object any thing to me, with humanity, and good nature (and I wifli
there were not many things to be objected) I fhall always be ready to give
them every fatisfaftion in my power, and if by no other means, at leaf! by
the modetly of my reply.
But now, returning to our fubject •, befides the dorfal glands, from
the turgefcency of which Mauchart (b) mentions, that Mangetus had
alio feen a coalition of the gula, there are others, I fay, which do not
always occur to anatomifts •, although the dorfal glands do not always
occur-, that are more morbid, or at leaft more frequently fo, which
may produce the fame effect, as thofe that were (den by the fame author
Mauchart (f), near to the termination of the oefophagus, and at the termi-
nation itfelf, would certainly have done, if their fwelling had been more
encreas'd, as thofe were, which Vallifneri (d) found, together with that
change into cartilage. And thus the fame thing happen'd in the very ter-
mination of the oefophagus, from a tumour that was either fchirrhous, or
made up of hard fat, the obfervations of Bonetus (e) in preference to others,
and of a furgeon commended by Mauchart (/), demonftrate. But there is
another part befides thefe, which exifts in all bodies, and which, by im-
moderately conftringing the lower part of the gula, produces an impedi-
ment to deglutition. This part is the diaphragm, betwixt the mufcular
flefh of which, the lower part of the oefophagus paffes. Wherefore you
fee, why in that fervant-man, whofe diaphragm the celebrated Heifter (g) faw
" very much inflam'd," there was an incapacity of fwallowing," and why
fome hyfterical women perceive, in the place juft pointed out, an obflacle
oppos'd to deglutition, as in that woman (b), in whom I accounted for it,
from thofe very mufcular parts of the diaphgram being convuls'd, betwixt
which there is a foramen, or fiffure, to tranfmit the oefophagus •, for that
woman, when fhe had, already, got her food down almofl to the ftomach,
perceiv'd an obftacle in that place. It gave me no fmall difpleafure, that
when I had found this foramen to be much fhorter than ufual, in fome bo-
dies, as in a certain old man who had been a porter (z)> and in another old
man, of whom I fhall write hereafter (£), had met with it, as well as the
oefophagus itfelf, which was in that part much wider, and more red, than
ufual, very large, efpecially in its breadth, I was much difpleas'd, I fay,
that I could get no certain information in regard to either, whether they had
perceiv'd any uneafinefs, or difficulty, in fwallowing, at that part.
17. And befides thofe that I have hitherto fpoken of, I have alio ob-
ferv'd, that there is another part, which may comprefs the oefophagus, and
that at the lower part. I mean the liver. For as there is an excavation, or
(£) Diff. cit. §. 12. (g) Differt. fift. obf. med. mifcell. obf. 15.
(f) §. 11. (/>) Epilt. 23. n. 4. &feq.
(d) Obf. fupra cit. ad n. 15. (/) Epift. 10. n. 19.
(e) Seft. hac Sepulchr. obf. 22. §. 2. (<0 Epiit. 37. n. 30.
(/) DifT. cit. §. 9.
D 2 hollow-
20 Book III. Of Difeafes of the Belly.
hollowing, in the posterior margin of this vifcus taken notice of by the ce-
lebrated Window (7), v/hich gives way both to the protuberance of the
fpine, and to the lower part of the oefophagus, when about to expand it-
felf into the ftomach ; it can be eafily conceiv'd, that if the liver mould, at
any time, become much fwell'd, particularly in this part, and hard, it may
prefs the oefophagus clofe upon the fpine. And, indeed, I fee that in this
feclion of the Sepulchretum (*»), the liver is taken notice of, among the
caufes of impeded deglutition, but not as being injurious in this manner,
although Ballonius (») feems to come fomewhat nearer thereto. There is
a far different method, which is a juft one indeed, but in part, by which
the celebrated Fantonus teaches (0), why, the ftomach being thruft down
into the umbilical region, by the vail bulk and weight of the liver, and its
fuperior orifice being comprefs'd, aliments and efpecially fluid ones, were
fwallow'd with difficulty, For he fays, " that the cavity of the oefophagus
" being thus elongated, by the force that was put upon it, had become much
'* narrower than ufual," and that the ftomach itfelf, being ftreighten'd by the
compreflion, had refifted the food which was about to enter into it. And I
think that the former part of this kind of explication, might be added to
the others, in order to render it more eafily intelligible, in the firft obferva-
tion of this feclion, why a foldier " being feiz'd with an opifthotonos, could
" fwallow nothing." For the neck being bent backwards, the oefophagus
is diftended, and thus as it becomes longer, fb much in proportion is it
made narrower, the anterior paries thereof approaching nearer to the pofte-
rior. And the fame kind of explication may, in fome meafure, take place,
where Hippocrates (p) fpeaks of " a diftortion of the neck" coming on,
fo that the patient " could fcarcely fwallow."
18. It does not, however, efcape me, that other caufes of injur'd deglu-
tition may be produc'd, fome of which you will even find in the Sepulchre-
turn. Yet you will not eafily be perfuaded, to enumerate among thefe as
certain, that which is promis'd in the thirteenth obfervation, by having this
title prefix'd to ir, " A difficulty of deglutition on account of the oefophagus
" being divided." For Blafius defcribes this tube to have been fo divided,
within the thorax of that boy, as to return into one cavity again, a little be-
low its divifion, or as anatomifts fpeak at prefent to have become infulated, or
have made an ifland. But of any difficulty of deglutition, he does not throw
in the leaft hint; fo that this conformation feems to have been more unufual,
than injurious. But we ought to form quite a different judgment, of that
which the excellent John Grafhuis (q) found, I mean a morbid dilatation of
the cefophagus, about the middle of the thorax, into a lateral fac, upon
which, fymptoms of deglutition, that were every now and then varying, de-
pended, and fymptoms that could never have been explain'd, without dif-
feftion. You may very foon expecl: another letter, which will, perhaps, be
fomewhat longer : but in the mean while, farewell.
(/) Expof. anat. tr. du bas ventre n. 259. (0) In fchol. ad patris obf. anat. med. 24.
(/») Obf. 26. §. 2. (/>) Seft. 4. aphor. 35.
{n) In fchol. ad. obf. 25. \q) Aft. n. c. t. 6. obf. 73.
4 LETTER
Letter XXIX. Articles r, 2. 21
LETTER the TWENTY-NINTH,
Contains a few flight Obfervations upon the Singultus or
Hiccup, and upon Rumination or chewing the Cud,
in Men. The other Part relates to Pain in the
Stomach.
I, A LTHOUGH you will find three fections, in the Sepulchretum,
±\. upon the next diforders of the ftomach, " the Singultus, injur'dcon-
" coction, and pain," one upon each, yet I would not have you expect as
many letters from me. For the two firft, when they are violent, are of
fuch a kind, that the one is found to be join'd with fevers, inflammations,
wounds, and other difeafes of the like kind, and the other with more con-
fiderable diforders, which it is either the confequence of, or has itfelf pro-
due'd, fo that they will be treated of, in conjunction with theie diforders, as
I am unwilling to repeat the fame hiftories. And this you will be able to
underftand, very clearly, immediately upon turning to thofe two fections,
which are written upon thefe fubjects. For in the fixth, which is upon in-
jur'd concoction, you will fee it exprefly declar'd to what difeafes moft of
the obfervations more peculiarly relate, and in what places they have been
produe'd more at large. And in regard to the remaining obfervations, all
thofe that are written with any degree of accuracy, of themfelves fuffkiently
fliow, whether they ought to be refer'd to any other fection. For there are
fome, in which you will not find a fingle word, upon the fubject of injur'd
concoction, as that which you have under number eight, article the fecond,
and that under number one, in the Additamenta. And why any obfer-
vation, like that which follows next, which refers to thofe perfons who
" were able to concoct, not to fay retain, their food, and had an appetite
" for it, almoft to the latter part of their lives," mould be inferted there,
does not at all appear.
2. And what obfervation is there of the whole fifth fection, from which
you are not refer'd to another fection ? Or if you are not openly refer'd, do
you not think that you might be with propriety, not to fay that you ought ?
And yet, even with all this farrago of repetition, the whole number of the
obfervations, when collected together, is but fmall •, notwithftanding one of
them (a) feems to be fet down more than once. For which reafon, I fhould
fuppofe four appendices were thrown in, that the whole fection might not
feem to be immoderately fhort ; in none of which appendices, any body is
{a) Conftr. obf. 6. cum §. 6. obf. 7.
mention'd
22 Book III. Of Diicafes of the Belly.
mention'd to have been infpe<5ted ; and that, for the fame reafon, two dif-
fections were added of ruminating men, which I fhould lefs wonder at, if
they had been given where the queftion is of vomitmg: nor is that fuffi-
cient •, for lad of all, a difcourfe on rumination, or chewing the cud, is
added from Peyerus, which is fo long as to exceed the length of the whole
fettion. But do not imagine, however, that thefe things are taken notice of
by me, as if I entirely dilapprov'd them-, but call to mind my intention.
And even attend to thefe few things, which naturally arofe in my mind,
when I read over thofe appendices upon the Singultus, and the obfervations
of men who chew'd the cud, fome from one occafion and fome from another,
as is generally the cafe.
3. In the fecond appendix, when Thomas Bartholin mentions among the
caufes of Singultus, a tumour that comprefs'd the nerves going to the
ftomach, and fays " it was fufpecled that there was a tumour of this kind,
*' in that man, whom I knew at Padua, and who was troubled with a perpe-
" tual uneafinefs from the hiccup •," the obfervation of Jo. Rhodius (b) came
into my mind, which relates to the fame cafe, and which, although it is
ibmewhat obfeure, may neverthelefs be look'd into by you. The fame
Bartholin afks, in the third appendix, " why juft opening a vein in the
" arm" fhould be of advantage in a certain Singultus, which he defcribes,
and which is really extraordinary ? What ? if the fuperior phrenic vein,
which you know accompanies the phrenic nerve, upon the quantity of blood,
which was about to return, to that part where it would flow into that vein,
being diminifh'd, having been, coniequently, reliev'd of a part of its load,
either prefs'd lefs upon its attendant nerve, or abforb'd fomething, from
whence this nerve was irritated ? And as in all thefe appendices, mention is
made of remedies againft the Singultus, nor even externals remain unno-
tie'd in the firft, and the fecond ; it brings to my mind the fuccefs of an
eafy, and obvious, remedy of Valialva's, in a noble Count, that is milk, with
which he fomented the abdomen •, for as long as the cloths were wet with
the milk, fo long was the Singultus, which was fo troublefome to the
patient, reftrain'd : in which, however, theriaca, when laid upon the part,
was not without its ufe.
But as to the remark, which is made in a kind of fcholium (c), that is
plac'd betwixt the third, and the fourth appendix, of a Singultus, which,
although it came on in a certain fever, that was attended with the worft of
fymptoms, was not mortal, it is a very rare inftance indeed, and the con-
trary is afTerted by two very eminent phyficians ; among the reft, Francifcus
Vallefius (d), and Hieronymus Mercurialis (e), who deny that it ever hap-
pen'd to them to be witneffes of a favourable event in a cafe of the kind,
nor did it happen otherwife to Hippocrates, in that woman who lay ill in
the forum mendacum.
And in the malignant fevers, in like manner, defcrib'd by our Rammazzini
(f), as many as ever were troubled with a Singultus, all perifh'd, and one of
(&) Cent. 2. obf. med. 6i. (e) Pnelett. pifan. in eand. hift. qua; ibi 26.
(f) Ad §. 6. obf. 7. (y) Cor.ltit. a. 1692 & duor. feq. n. 22.
(d) Comment, in Hippocr. epidem. 1. 3. f 2.
aegr. 12.
them
Letter XXIX. Article 4. 23
them beino- diflected, the ftomach was found " to be mark'd here and there
" with black foots :" and what was found, in the ftomach of a certain man,
who had been affe&ed with the hiccup, you will learn from the Opufcula Pa-
tbologica of the celebrated Haller (g). Ledelius, however (b), after having
quoted Epiphanius Ferdinandus, as " calling God to witnefs, that he had
*' never been deceiv'd in predicting death in ardent, and malignant fevers,
" which were attended with a Singultus," prudently admonifhes us, " that
" a patient ought not to be deferted, as long as there is life, becaufe pro-
** digies many times happen, in the cure of difeaies," as happen'd to him
in a certain baker. And not to him alone, but to others alfo, as to Lanzonus
(i), the celebrated Delius (k), and to me, in that epidemical conftitution
at Forli, in the year 171 1, which I have already defcribed to you (I). For
the two patients, whom I mention'd, in the firft place, in that defcription,
were ftill alive when I wrote thefe things ; although whoever had then ken
them, and particularly Garavini, who was more like a dead perfon, than a
living one, for fome days together, and had heard, befides, the frequent
Singultus of each, would have immediately given up all hope of their re-
covery.
4. But as to men who chew the cud, examples of which Peyerus has col-
lected, in the greateft number he was able (»*), and has refer'd fome to ru-
mination which was in-bred, and congenial, as it were, and others to that
which is the confequence of difeafe ; the fame perfon has imagin'd that two
obfervations, of a nobleman, and of a monk, both of which you fee here in
the Sepulchretum (n), relate to thefe two kinds, one to each. Both of them
were made at Padua, and are the firft of them all, and the only obfervations,
befides, which are join'd with diflTe&ion ; one thing is very foolifhly added
here, " that this monk had two horns." For Rhodius (0) does not fay it,
in which Peyerus blunders (/>), though he otherwife juftly blames Bartholin,
who has added it (q), and thoie who have follow'd Bartholin.
Certainly, Fabricius ab Aquapendente (r), as he took notice of this fame
monk, would by no means have omitted that circumftance, inafmuch as he
had, a little before, thought it quite neceffary to add, " that the father of
" this ruminating gentleman, had born a little horn on his head. And
" among others, who copied that blunder of Bartholin, was Etmuller (j),
*' who added one of his own, over and above •, I mean that in thefe rumi-
" nating men, the ftomach had been obferv'd to be much more fibrous,
" and flefhy, than ufual, as if it had been cover'd with a mufcular coat."
I wifh we could fo defend him, as to fuppofe, that by the term Jtomacbus he
meant the cefophagus ; for this part Plazzonus (r), really, found " every-
*' where flefhy, like a mufcle" that is, not only fuch, as " all men evident-
ly have," as Tryerus would have it fuppos'd («) •, for unlefs it had beer
(j) Obf. 14. (/) C. 6. cit.
(i>) Eph. n. c. Dec. 3. A. 7. obf. 127. (^) Cent. 5. hift. anat. 61.
(/') Earund. cent. 1. obf. 61. (r) De ventric. inteft. &c. ubi de vari,
(/■) Ex. aft. T. 8. obf. 108. ventric. in fin.
(/) Epift. 7. n. 16. (s) Prax. 1. I. f. 4. c. 1.
(ot) Merycol. 1. 1. c. 6. & 1. 3. c. 3. (/) Vid. Rhod. obf. cit. 59 quas 9. in Se-
(») Obf. 10. & 9. pulchr.
(0) Cent. 2. obf. 59. («) C. 6. cit.
much
24 Book III. Of Difeafes of the Belly.
much more flemy, an anatomift, of fome eminence, would not have obferv' J
this one thing only, at the fame time that he pronoune'd " all the other
" parts of the body, to be in their proper Itate." But for Etmuller •, if how-
ever he did write thefe things ; we cannot make ufe of this defence, inaf-
much as he •, which all the things that he had faid before, in that chapter,
mow-, by the term Jiomachus always meant ventricutus or ftomach.
Yet that blunder of Bartholin is ftill more considerable, where he left
thefe words, in his Anatome quart urn renovata (x) : " and indeed we cannot
doubt but the ftomach was double, in a ruminating man, fpoken of by Sal-
muthus and others." And I wonder that this mould have been transfer'd
into the Sepulchretum, in that Scholium, which is fubjoin'd to the two ob-
fervations, that teach the contrary, of which I have hitherto fpoken, efpecial-
ly as Bartholin could produce no difiection, befides thefe, of a man who
chew'd the cud, not even from Salmuthus, and as, moreover, hares, and
rabbets chew the cud, and neverthelefs have not two ftomachs.
5. However, although it never happen'd to Valfalva, nor to me, to fee
men who chew'd the cud, and much lefs to diiTecl: their bodies ; yet it has
happen'd frequently to us, to difTecl the bodies of men, who had been
troubled with a violent pain in the ftomach, of which the feventh fection,
as I have faid' above, profeffedly treats. And the obiervations of this kind,
which I fuppofe to agree better with the purpofe of this letter, than thofe of
others, I (hall immediately purpofe. And firft I fhall give you three from
Valfalva.
6. A man of fixty years of age, of a bilious conftitution, had begun, for
many years, to complain of a weaknefs, and pain, in the ftomach, when at
length a hardnefs, about that region, came on, below which, fome hard
globules befides (but thefe were very moveable) were perceiv'd, and attend-
ed with fome tenfion of the whole belly. The belly, when fhaken, evi-
dently fhow'd that a kind of humour was extravafated within it. There were
frequent borgorigmi of the inteftines, and eructations of flatus. Vomiting
return'd, more than once, at the diftance of fome hours after eating •, which,
however, had happen'd but feldom in the firft years of the difeafe.
In the mean while, the patient made but little urine, was very thirfty, and
complain'd of a drynefs of the tongue : his pulfe was weak, and fmall. At
length, though a great quantity of ferum was difcharg'd, by the urinary paf-
iages, and the fwelling of the belly was diminifli'd, yet the other difagreeable
fymptoms, neverthelefs, becoming every day more and more fevere, and the
vomitings being in the laft month of his life, of a kind of ferum ting'd, as
it were, with foot, and fmelling very ftrong, fo that the patient, himfelf,
faid it refembled the bad fmell of putrid flefh ; his ftrength was gradually
diminifh'd, his fpeech became Hammering, and he died.
The abdomen, even then, contained a pint, or two, of ferum, fimilar to
water, in which frefh meat has been wafh'd. The whole omentum was con-
tracted into> certain tuberosities of different colours, which were mov'd, as
that was mov'd. The ftomach overflow'd with ferum, of the fame kind
with that, which was thrown up by vomiting : but it was become quite
hard, in about a third part of it: this part lay towards the pylorus, and had fo
(a) L. i. c. 9.
ftreighten'd
Letter XXIX. Articles 7, 8, 9. 25
ftrcighten'd it, that the aliments had fcarcely room to pafs tiirougli, after be-
ing prepar'd in the ftomach, Bat although the whole of this hard part,
when cut into, fhowM a white and (olid fubftance internally, of which it
con lifted •, yet on that fu trace, which was turn'd towards the cavity of the
itomach, it entirely refcmbled both in colour, and fmell, putrid flefh, dii-
tinguifh'd with certain bloody points.
7. You fee that thole hard, and moveable, globules below the region of
the ftomach, were the tuberofities into which the omentum had contracted
itlelf: and that the upper hardnefs was a fchirrhus of the ftomach, which as
long as it did not extend itlelf by its encreafe, lb as to comprefs the pylorus,
and ftreighten the paflage through it, did not caufe the vomitings to happen
fo frequently. The pain alio, in the beginning of the difeafe, was but
flight, as it arofe only from fome weight of the fchirrhus, and from the re-
fiftance of the coats, which it occupied, to the proper extenfion of the
ftomach being made, for the reception of the food, or if this diftention was
brought on, from that part of the coats which was ftill found, being
incapable, of themfelves, to bear all the diftention that was necefiary, with-
out uneafinefs. But when the fchirrhus was encreas'd, and degenerated, at
length, into a cancer, and that ulcerated •, the pains muft, of courfe, more
and more encreafe. For the ftomach being thus affected, concoction being
vitiated, and the balmy nature of the blood deprav'd, it is not at all to be
wonder'd at, that the other circumftances of the hiftory, fhould alfo happen,
efpecially as that hardnefs of the ftomach, and the tuberofities into which
the omentum, that is connected to the ftomach, had contracted itfelf, made
a refiftance to the free courfe of the humours. And from thefe confidera-
tions we may very well conceive how flatus, vomiting, afcites, weaknefs,
and death, were the confequences of the original difeafe.
8. A woman of forty years of age, of a flefhy habit, but a fallow colour,
having eaten onions, prelerv'd in fait, and vinegar, together with bread made
from the meal of chefnuts, began immediately to complain of a pain in her
ftomach. Which growing more and more violent, at the end of three hours,
after eating this meal, fhe died in cold fweats, and a fatal fyncope, which
had feiz'd her.
Her belly being open'd, on account of a fufpicion that fhe had been poi-
fon'd, every thing was found to be in its natural ftate, except that the
ftomach was diftended to a very great degree, and fomewhat inflam'd ; but
the blood prelerv'd nearly its natural fluidity.
9. Valfalva thought proper to make this conjecture, in regard to the
caufe of the difeafe, that an eftervefcence being excited by the incongruity
of that kind of food, this very great diftention of the ftomach had been,
confequently, brought on, which, by comprefllng the fanguiferous veftels
thereof, caus'd a remora to the blood's motion, from, whence inflammation
arofe, and from this, an irritation of the nerves of the ftomach, from whence,
again, a fyncope.
But however, this hiftory may confirm what Diphilus, and Mnefithsus,
fay in Ludovicus Nonnius (j), of chefnuts, and the experience they had had
(y) Diatat. 1. i.e. 45.
Vol. II.. E of
26 Book III. Of Difeafes of the Belly.
of their power of caufing flatus •, yet the fame author does not deny, that
they are in very common ufe, among many of the people inhabiting the
Alps, and it is commonly known, that a bread is even made from their meal,
which thofe people feed on in common, where, as Avantius (z) alfo afferts,
" a great quantity of them grows." Muft we therefore, accufe the onion,
which was added to that kind of bread, and fuppofe it, by means of its ac-
rimony, to have attenuated, and cut, the grofs particles of the cheihuts,
and fo let loofe too great a quantity of air ? As if, truly, the fame ruftic in-
habitants of the Alps did not eat onions, occafionally, with their bread.
This woman, however, feems to have had a ftomach fomewhat weak, and
unaccuftom'd to fuch a kind of food ; and thofe ruftics feem to have, as
Horace (a) fays,
Dura mefforum ilia ;
The reapers brawny fides.
But I believe that thefe circumftances were much better known to thofe who
knew the woman, than to us. Whence then could the fufpicion of poifon arife,
as they were not unacquainted with all thefe things ? For if the woman had
cramm'd herfelf, with an immoderate quantity of this food, there is no doubt
but they would have known it, and have had lefs reafon to fufpect poifon.
You fee, in this very feventh fection of the Sepulchretum (£), that a little boy>
in like manner, " died within the fpace of three hours," from the immoderate
eating of grapes. Yet there appear'd, at the fame time, another reafon, why
this child died in that manner. " For the ftomach being perforated, con-
tained a great quantity of green ichor, which, without doubt," fays Rho-
dius, the writer of the obfervation, " was an a^ruginous bile," that was en-
dow'd with a very great acrimony.
How then was the cafe ? I fhould be entirely of opinion, that in this wo-
man, alfo, there was fome other peculiar circumftance lying hid, although
it did not fall under the notice of the eyes, in diffection, fo that by this fhe
was already difpos'd, if any caufe did but happen to be added, as that fla-
tulent and unufual kind of food, fhe was, I fay, fo difpos'd, as to be af-
fected in this manner therefrom, though fo many others are not us'd to be
at all affected by the fame diet, whether this difpofing circumftance lay hid
in thofe juices, which the food met with in the ftomach, or in the nerves,
which were endow'd with a more exquifite fenfe, and confequently more prone
to irritation, and more ready to transfer that irritation to any other part,
that is to the heart, in particular, to which the fame nerves go, that go to
the ftomach.
In this manner therefore, or nearly fo, you will underftand what Valfalva
conjectur'd : although we have fcarcely any proof of the bad habit of this
woman, from the fallow colour of her fkin. Without doubt, in two other
women, both of whom had eaten a melon, the one " ftew'd in an oven with
onions, and pepper," after which fhe drank cold water, and the other, " boiled
in milk, and well feafon'd with pepper," after which fhe drank cold, and four
fmall beer, and who were both taken off foon after by a fudden death ; in thefe
(z) Not. ad. Fiene ccenam, ubidejpane non (a) Epod. 3.
tumeatac. (6) Obf. 7.
2 women
Letter XXIX. Article 10. 27
women I fay, without doubt, abad dilpofition of body was more evident, as in
one of them there had been a fuppreffion of tjie menies, for thefpace of three
months, and in the other, belides an advane'd age, of feventy years, a long
weaknefs of the itomach, and a decreafe of ftrength. Yet there is alio no doubt,
but Chriftophorus Seligerus (f), and Michael Erneftus Eumuller (i), obferv'd
more cacheclic appearances in the body of one before diifeclion, and more
morbid appearances in the Itomach of both, or at leait of one, by means of
diffection.
10. A nobleman of Bologna, who was aged more than fixty, by one year,
having been already troubled, for many years, at one time, with a hemi-
crania, and at another time, with a gout, which was frequently vague, and
wandring, and fometimes alfo fix'd, and at other times with calculi of the
kidnies, was, lafb of all, feiz'd with a gout in the right hand, without any
tumour, but with a mild pain, which, as the power of feeling was foon be-
come lefs quick, and ftrong, could fcarcely be perceiv'd. His hand be-
came entirely well ; but in the mean while the right kidney was painful.
But here alfo the pain was alleviated, fruitlefs Teachings to vomit often re-
curring : however, when the vomiting ceas'd the gout feiz'd, in the fame
manner, upon his lower limb, and gave the patient excruciating pain at his
calf, and at the ankle joint. After one or two days having pafs'd, that
whole extremity of the foot was entirely depriv'd of the powers of feeling,
and moving. Yet the day following, fome fenfe of pain return'd to the
paralytic foot, and to the patient, both good fpirits, and good pulfe, which,
at other times, was, for the mod part, intermitting, and unequal, in the right
arm.
At length, the day before he died, he threw up his food, mix'd with a
watry matter : and felt a flight pain, with pulfation, and heat, at the region
of the ftomach. A little after that he vomited twice a yellow humour.
On the following night he flept but little. In the morning, he complained
with a very low voice, of three things, which had been continually trouble-
fome to him, a great thirft, a bad tafte in his mouth, and loft appetite :
and the fever, which had before difcoverVl itfelf, in the pulfe only, and that
at times, was now evident. But the pain, and pulfation, of the ftomach,
continuing, with a great heat in the back, the pulfe, which had been very
languid, the evening before, was now, from a great difcharge of blood, by
ftool, totally aboiiihed.
With this blood was mix'd a matter, that fmelt very ftrong, and which,
like melted pitch, follow'd the ftick that was put into it, if you drew it
back. In the mean while, the foot was very much in pain ; and there was
a fenfation of fomething afcending, as it were, through the leg, and after-
wards a fenfe of weight, in the lower part of the belly. But in the right
arm, the power of motion was gradually loft, the nails of the fingers be-
coming livid : and that arm was foon after render'd quite paralytic. Some
hours before death, frequent tremors were perceiv'd, about the prsecordia.
The difcharge of blood returning by ftool, as before, 'and the vomiting of
the fame kind of matter, perhaps, being at hand (as a naufea, and ill fmell,
like that of fasces, proceeding from the mouth, feem'd to fhow) the
(<-) Eph. n. c. dec. z.a. 1. obf. 139. (d) Earund, cent. 9. obf. 66.
E 2 patient,
28 Book III. Of Difeafes of the Belly.
patient, faying he was fuffbcated, died about fix and thirty hours after being
attacked with the pain of his ftomach.
The abdomen being open'd, the whole fubftance of the inteftines was
found to be occupied with a dreadful inflammation, from the ftomach,
quite to the termination of the rectum, fo that not the leaft part of them
was left unaffected with it. And in the inteftines, a bloody matter, like that
which had been difcharg'd, was. contain'd. The ftomach and the kidnies
were found. In the thorax, the pofterior parts of the lungs, and particularly
on the left fide, were flightly inflam'd. In the pericardium, was a fmall'
quantity of water. In the heart were no polypous concretions.
1 1. The aphorifm of Hippocrates (<?), " If any perfon that is weaken'd,
" and emaciated, by an acute, or long continued diforder, or even by a
" wound, or from any other caufe whatever, difcharge atra bilis or black
" blood, as it were, by ftool, he dies on the day following," except that it
feems to have been fulfill'd in a fomewhat fhorter fpace of time, fquares ftill
better with this cafe, than with that to which it is applied by Ballonius, as
you fee here in the Sepulchretum (f). For his patient, who was, in the
fame manner, troubled with pains, at the region of his ftomach, did indeed,
*' difcharge an atrabilious blood," the day before he died, but it was " by
" the mouth." However Ballonius did not defcribe any diforder in the
ftomach itfelf, and Valfalva has reprefented it as being lound. Both of them
difcover'd fuch appearances, near the ftomach, that might eafily account for
the affection of that part. And the puliation which was remark'd by Val-
falva, was without doubt the effect of the blood, which was collected in the
rieareft parietes of the inteftines, and the caufe of its difcharge into their ca-
vity. For the veffels, by having their coats ftill more and more diftended,
■were at length ruptur'd, and had their contents evacuated. To which, per-
haps, a part of that prediction, to return to Hippocrates, may be applied
(g) : " palpitations about the belly fhow an eruption of blood to be at
" hand."
But be that as it will, this one thing is certain, that almoft all the force
of fo long, and fo various, a difeafe, had, at length, fuddenly fallen upon
the veffels of the inteftines, and had drawn the ftomach, which is conjoin'd
by veffels, with the inteftines, and even by the very fubftance itfelf, into
confent with them. So you will fee it was drawn into confent, in another
perfon, who, through the whole courfe of the difeafe, had difcharg'd a black
matter by ftool, and in another, alio, in whom the upper part of the in-
teftines had grown livid. Thefe two hiftories, you have in the fifth fection
preceding (&), which relates to the Singultus. And, without doubt, you
would have a third alfo, in this (t), where all the inteftines are defcrib'd as
being extremely red, from inflammation, if the difeafe were alfo defcrib'd, as
the diffection is, without which I wonder how this, and perhaps others,
came to be plac'd among thofe that relate to the pain of the ftomach.
And certainly, in the volumes of the Casiarean Academy (£), you will
find more than one obfervation, wherein not only the ftomach was affected,
(e) 23. §. 4. (h) Obf. 1. & 6.
(f) Obf. 19. CO Obf. 50.
(g) Pr&dict, 1. 1. a. 20» (*) Dec. 3. a. 9. obf. 222. & aft. t. 2. obC
108. 2. loCO.
a while
Letter XXIX. Article 12. 29
while the patient was living, but alio an inflammation, or bad (late, in fome
meafure, of the interlines, and not of the ftomach, was found after death. But
if, in regard to that obiervation, which I juft now copied from Vallalva, you
rather afk, why the intefbines themfelves, as they were lb very much aftedt-
ed, were not, confequently, excruciated with the pain, by which the confent-
ing ftomach was attacked ; I believe I (hall not be very far fhort of truth,
if I fuppofe that, as in this man fo many nerves fpeedily, and frequently,
became paralytic, the nerves which went to the inteftines, alfo, were rcfolv'd.
But now I will likewile add fome of my own obfervations, as I have pro-
mis'd.
12. A woman of forty years of age, who had been us'd, for the mofh
part, to eat fait victuals, and drink generous wine, had been for many years
Fubject to pains of the ftomach, of which, a lofs of appetite for food, and a
naufea, were the coniequences, and thefe were foon after follow'd by repeat-
ed vomitings of blood, with a continual fever, watchings, and third. And
although the belly, when examin'd with the hand, never difcover'd any re-
markable hardnefs, in any part of it ; yet the region of the ftomach was not
quite free, at times, from an uneafy fenfation when fcarcely any preflure was ap-
plied, and this even when the more violent pain was abfent. She complain'd
alfo of her loins •, but this was only, either when fhe was about fome greater
labour than ufual, or when fhe lifted any confiderable weight.
A very obftinate pain of the head was, moreover, fometimes added, to
the other complaints. Againft all thefe diforders of the ftomach that I have
mention'd, as often as ever they recur'd with any great violence, blood-letting
was always of fome advantage : drinking plentifully of water alio, in which
a piece of bread, only, had been boil'd, was likewife of great ufe : and fl\e
feem'd, more than once, to have been quite recover'd, by the long ufe of
milk-diet, and receiv'd frelli fpirits every month, by the difcharge of blood
from the uterus, which continued regularly to the time of her death. In this,
manner it was that death came on.
Not long before, a hard tumour appear'd on each fide, above the clavicles,
where the external jugular vein goes down on the neck •, this tumour created
pain, nor would yield to any remedies, fo that it encreas'd every day, and air
ready caus'd refpiration to be carried on with fome difficulty. To this was ad-
ded a continual fever, increafing in the evening, with which a little rigor was,.
fometimes, obferv'd. She complain'd that her head was in pain, befides.
her ftomach, where the pain was continual: with which, however, there
never was, at this time, any vomiting of blood. She had, continually, a
troublefome thirft, and a fenfe of very great bitternefs in the mouth, from
which, in the latter days of her life, a very ill fmell proceeded ; but no pus
ever was obferv'd to have been difcharg'd therefrom. Under thefe fymp-
toms, fhe drag'd on life much longer, than could have been fuppos'd from,
her pulfe, which, befides its being already fmall, and weak, frequently be-
came fmaller, and more weak, particularly in the laft fifteen days, when fhe
took nothing but broth, and a little wine, as fhe could now bear no kind of
aliment befides, and much lefs medicines.
This lean carcafe was brought into the anatomical theatre, when, as I was;
teaching anatomy, in the month of February, of the year 1 744, and had
already
30 Book III. Of Difeafes of the Belly.
already demonftrated the male organs of generation, the female organs were
wanting. The belly, therefore, being open'd, I faw the omentum roll'd up
towards the upper part of that cavity, and extended fo, that the tranfverfe
arch of the colon immediately occur'd to the eye, being now below the navel,
whereas it generally lies immediately below the ftomach. Into which fitua-
tion it, probably, might have been pufh'd down, by the ftomach, in fome
mealure, though not entirely, as the left part of the fundus, of this vifcus,
defcended lower than ufual.
And the ftomach was even livid externally, and particularly in a very
confiderable part of it, and had, at the fame time, its coats very much thick-
en'd, and harden'd, unlefs where they were, already, become fo rotten as
to be broken through with a touch, and to difcharge a matter of a cineritious
colour, and of a very ftrong fmell, which, like a kind of fluid pultice, was
contain'd in the cavity of the ftomach. Into this cavity, it had burft out
of the pofterior paries of the ftomach, which was immoderately thick, to
a great extent, and internally tumid, and, in the fame place, unequal, in a
corrupt, rotten, and gangrenous ftate, and of the fame lurid colour as the
foremention'd matter was, fo as to make it certain, that a tumour, or ab-
fcefs, of the worft kind, had been ruptur'd in this place.
The pylorus was found, and all the inteftines, among which was the co-
lon, were, as it is reafonable to fuppofe, after fo long an abftinence from
food, contracted, from the beginning to the end. The fpleen alfo was
found, except that it was, in proportion, larger than ufual, and, internally,
fomewhat pale. But the right part of the liver fhow'd fome roundiih and
white fchirrhi, about the fize of fmall grapes. Thefe tumours lay at a little
diftance from each other, on the furface, in fuch a manner, as to be, in fome
meafure hidden, within the fubftance of the vifcus •, and when I cut into the
liver, I faw one of them, which was intirely fimilar to the others, that was
quite buried within the fubftance. There was a great quantity of bile in
the gall bladder, which was extremely yellow, and had ting'd the neigh-
bouring parts with the fame colour.
The pofterior furface of the left kidney had an oblique line upon it, to
a confiderable length, and of a whitifh colour, made of a kind of tendinous
fubftance, as it were, which, as I perceiv'd, when I cut into the kidney,
was carried to a great depth, fo as to reach to the tubuli, in which the papillae
are receiv'd. You would have been ready to fuppofe, that it was the cicatrix
of a former ulcer, fo much fimilarity had it thereto : but no where did there
appear any mark of injury, though we look'd for it in the neighbouring tu-
nica adipofa, and in the mufcles of the belly.
The uterus was fmall, and low, and very much inclin'd to the right
fide, fo as to be much nearer to that fide, than to the left. . But
the round ligament was, alfo, fhorter on the right fide, than on the
left. The cervix uteri, and ftill more the os uteri, were nearly in
the fame ftate, in which they are generally found, in virgins •, for the
former was internally mark'd, with its oblique, and prominent rugs, and
the latter had its aperture very round, and narrow. Nor was the ring of the
hymen wanting, notwithftanding it was very low, and fhow'd no traces of
rupture. Yet behind it, were none of thole roundifii caruncles, and but
very
Letter XXIX. Article 12, 31
very few rugas in the vagina, and thefe very flight, and the fkin, which at
the lower part of the abdomen, I obferv'd to be, as it were, of a whitifh
colour, and fpotted, did not greatly agree with what I had obferv'd be-
fore.
The teftes, in proportion to the age of the woman, and the bulk of the
uterus, were large, and externally convoluted •, but internally, the left had a
kind of fmall and empty cells, wrap'd up in a white, and thickifh mem-
brane, and the other contain'd, in a cell, not much larger than thole, a
black, and half-concreted blood. The right falopian tube was pervious
to the ovarium, but in the remaining part fhut up •, on the contrary, the
left was open only to the uterus. It was furprizing in fo lean a fubjeci:, ex-
cept we allow for its being a female body, that there was fo considerable a
quantity of fat in the meientery, and that even fome remain'd in the omen-
tum, and that in the inrerftices of the mulcles, alfo, on the back, and the
limbs, a much greater quantity was found, than thofe who prepar'd the
body would have wifh'd ; and thefe mufcles were of a very elegant red co-
lour.
Beneath that yellow fat, with which the mefentery cover'd the vertebras
of the loins, and the trunks of the large veffels, that adher'd to them, fome
glands lay hid, which were enlarg'd to a great degree, and fo clofely con-
nected to thofe veflels that they could not be feparated, without great dif-
ficulty. All thefe glands were internally white, not very hard, but abound-
ing with a purulent ichor. The others, throughout the mefentery, were not
enlarg'd. But near the ftomach, I obferv'd one of the lymphatic glands to
be grown much thicker, than natural, and harder, and to be of a lurid co-
lour.
I then alfo faw, that the pancreas was univerfally thicken'd, and, at the
fame time, fomewhat dry, and become a little hard, if you except a certain
part of it, which had grown out into a white fubftance, almoft like the
thymus.
When we open'd the thorax, we, firft of all, found the two loweft jugular
glands to be of a whitifh colour, and enlarg'd in every one of their dimen-
fions, to the breadth of two inches, at leaft. Thefe glands made up that
hard tumour, on both fides, which I mention'd before •, for they were alfo
found to be hard, notwithstanding that on the infide, they contain'd a pu-
rulent ichor, part of which flow'd out, while the clavicles, under which,
and the neighbouring part of the fternum, thefe glands harbour'd them-
felves, were taken away. The other jugular glands were, alfo, fimilar to
thefe, in colour, and hardnefs, and in the ichor they contained. Yet thefe
4iad not grown out into fo large a bulk.
The axillary glands, however, had not been encreas'd in their bulk, nor
undergone any other change whatever. On the other hand, thofe that are
plac'd at the firft divifion of the afpera arteria, were of a blackifh colour,
mix'd with white •, and from a very fmall fize, were become not lefs than
middle-fiz'd grapes : they were likewife pretty hard, and abounded with
the fame kind of purulent ichor, which I faid was contain'd in fo many
other glands.
Yet the afpera arteria itfelf was found, even in the neck, as the whole
trad
32 Book III. Of Drfeafes of the Belly.
tract of the cefophagus was, in like manner, from the upper part, to the
lower. Nor was any diforder obferv'd in the lungs, which werefomewhat tur-
gid with air: nor yet in the heart, if you except fome roundifh tubercles,
of a deprefs'd figure, made up of a fomewhat hard, and compact fubftance,
and fo frequent, as to be almoft contiguous to each other, which befet the
whole borders of the mitral valves •, and in one of the femilunar valves, a
kind of fmall fcale that had grown to it, but was not yet become bony.
Finally, the brain was not only not lax, but inclining to hardnefs,yet feem'd
to be nearly in its natural ftate, unlefs that in the lateral ventricles, there was
fome quantity of a pellucid water, and the plexus choroides was pale. But
the pineal gland was a little more firm, and globular than ufual, and in-
clin'd more to a white colour, than it generally does. And, notwithstand-
ing moil perlbns, now, do not take this for a gland, yet I thought it might
not be amifs, to take notice of this circumftance, in a body wherein fo
many glands were obferv'd to be difeas'd.
13. The fame obfervation makes us fufpedt, that the beginning of this
long difeafe, which at laft carried the woman off, was in fome gland of the
ftomach, which being gradually encreas'd, and grown hard, afforded, by its
tumefaction, an obftacle to the courle of the blood, for which reafon it burft
forth, more than once, from the neighbouring veffels that were dilated, and
particularly, in a woman who made a free ufe of generous wine, and fait
provifions. And after that by this kind of intemperance, not only the bulk
of the gland, and the extenfion of it, had been by degrees, more and more,
augmented ; but alfo the nature of the included humour had become more
deprav'd, a purulent corruption, at length, came on, from whence, even
before the tumour had any aperture in it, fo great a quantity of ill-condi-
tion'd ichor had been thrown into the fmall veins, and the lymphatic
veffels, that many other glands were infected with the fame taint.
If the woman had liv'd fome time longer, it is not difficult to forefee,
by way of conjecture, what would have happen'd to the pancreas, and the
Icirrhi of the liver. As to there being a great quantity of bile in the gall-
bladder, it is not at all furprizing, as I faid in the preceding letter (I), that
this mould happen, where, for a long time, nothing had been contain'd in
the ftomach, and the upper part of the inteftines, which by diftending them
could comprefs this receptacle. And as to the neighbouring parts being
ting'd with the colour of the bile, this is a circumftance which happens fo
frequently, in dead bodies, that in regard to accounting for any diforder
therefrom, it is fomewhat more natural to follow the laft fcholium, which is
fubjoin'd to the fixteenth obfervation, in this fection of the Sepulchretum,
rather than the obfervation itfelf, efpecially in this cafe, where there was
in the feveral parts of the body fo great a number of real, and certain, ap-
pearances of difeafe.
However, if you mould defire to have other examples of tumours, or ab-
fceffes, in the ftomach, befides thofe which are to be found in this, and the
next, that is the eighth, fection of the Sepulchretum ; you will find fome to
add to them, among the monuments of the Casfarean Academy (m)> and
(/) N. 6. (/«) Dec. 3. a. 5. obf. 175 & a. 7. obf. 142. & cent. 3. obf. 13.
from
Letter XXIX. Article 14. 33
from other books befides, but in particular, from the works of Frederic
Hoffmann («).
14. An old woman had, already, lain fome months in this hofpital, on
account of a tumour which rais'd up her belly, about the navel, and be-
low it, but more on the right fide, than the left. For which reafon flic
could not lie down on her left fide. The tumour was really large, but leem'd
larger, for this reafon, that the hypochondria, and moft of the other parts of
the belly, hadfubfided much, from a lofs of flefh, which was universal through
the whole body, but moft confiderable on the left fide : could this happen
becaule the woman always lay on her right ? The tumour feem'd very move-
able, if you took hold of in betwixt your hands, and pufh'd it to one fide,
and to the other. And it had fcarcely any pain.
On the other hand, there was a perpetual complaint of a kind of uneafy
feniation, in the ftomach. For which reafons, fome .were ready to conjec-
ture, that this tumour was in the omentum, by which means the ftomach
was drawn downwards, and troubl'd in its functions. With this uneafy fenfe
in the ftomach, there was fometimes a defire to vomit, but no vomiting.
And now there was, befides thefe fymptoms, a continual kind of fever, which
continued, in conjunction with all the other fymptoms, that I have fpoken of,
even to the very clofe of her life, that is to the middle of October, in the.
year 1735.
The belly being laid open after death, it was evident that the tumour was
in the right ovarium : which had grown out into cells, full of a foft matter
indeed, but not fluid, and of a cineritious colour inclining to yellow, but
without any difagreeable fmell. The tumour was increas'd, by the neigh-
bouring tube being condens'd with it, which was, alio, much enlarg'd, and
become pretty thick ; whereas the uterus, and the other parts that belong to
it, were only of their natural fize, and in a found ftate. This tumour was
connected to the contiguous fide of the pelvis, and in fome meafure, alfo,
to the neareft inteftines, fo that it could be more or lefs mov'd, by means of
moving thefe parts. The inteftines were livid from inflammation : yet they
had no bad fmell, nor yet the ftomach, which was brought to me, by the
perfon who diflected the body, and by whom, the other circumftances, that
I have hitherto fet down, were accurately related, that is by our Mediavia.
The reafon of his bringing the ftomach to me, was that I might, after
having examined it, clear up a certain doubt of his. The cavity of it was
very much contracted, on its internal furface, here and there inflam'd, in fe-
veral places, and in the very middle of the neck, or upper part of the
ftomach, was an ulcer, nearly of a circular figure, which, in its diameter,
was fomewhat fhorter than three fingers breadths, and of a very fmall depth,
as in it there appear'd to be a great number of lenticular glands, of a mid-
dle fize, and fo very manifeft, that I inferted a briftle into an orifice, which
wa3 feen in the center of them. Yet this nicer was furrounded with pretty
thick lips : and the fubftance of the coats of the ftomach was become more
thick, and hard, in that whole fpace which correfponded, externally, to the
ulcer, than in any other part.
(>;) Medic. Rst. t. 3. §. 1. c. 7. §. 26.
Vol. II. F But
34 Book III. Of Difeafes of the Belly.
But as the ftomach was entirely perforated, almoft in the middle of the
ulcer, Mediavia enquir'd of me, whether I imagin'd that this foramen
could have been accidentally made, with the knife, in taking out of the
ftomach-, for he affirm'd, that nothing had been found in the belly, befides a
little ferum, in the lower part of the pelvis, which could be fuppos'd to have
been extravafated, out of the ftomach, whereas it feem'd that much ought
to have been effus'd, in confequence of the patient having been, conftantly,
in a recumbent pofture.
I however, although I thought it but little probable, if the ftomach had
really been cut by the knife accidentally, that this mould have happen'd in
that part, in particular, which correfponded to the middle of the ulcer,
nor did the figure, and magnitude, of the foramen, which was almoft capa-
ble of admitting a little finger, feem to be of fuch a kind, that they could
properly be refer'd to the point, or the edge, of the knife •, yet that I might
fatisfy both him and myfelf, as we were both equally defirous to know the
truth, I examin'd with accuracy, a fecond, and a third time, the edges of
the ulcer. And when I faw them to be not only callous, but unequal,
and the more the foramen went towards the outfide, to be comprehended
in the lefs circumference, which two circumftances, the knife certainly
could not have been the caufe of, by having cut from without inwards ; I
judg'd that this aperture was not to be attributed to the knife, but to dif-
eafe.
For as to nothing having been extravafated, from the ftomach into the
belly, that might have happen'd for this reafon, that the external membrane
was, by degrees, extenuated, and not entirely eroded, or perforated, till the
difeafe was come to the laft extremity, and life was at the clofe, at which
time the ftomach of the dying woman, being corrugated, and contracted,
had nothing at all to pour out.
15. 1 lit, afterwards, on an obferration of Mercklin, which you will alfo find
to be related here, in the Sepulchretum (0), that is, of a foramen, big enough
to admit the extremity of a man's thumb, with eafe, feated, in like man-
ner, in the upper part of the ftomach, at which part there had been, for
many years, a continual pain, not very confiderable indeed, but always
pretty troublefome. And that foramen was alfo fuppos'd, by this learned
man, to have been open'd after an old erofion, but only in the latter part
of life ; for he judg'd that life could not have been drag'd on fo long, if the
food that had been taken in formerly, had been effus'd into the cavity of
the ftomach, as he obferv'd lbme, which was taken in the day before her
death, to have been.
In the fame manner, likewife, you will explain a much more recent ob-
fervation, that you read in the cc nmentaries of the illuftrious Academy of
Sciences at Peterfburg (p), of a fiffure in the ftomach, through which no-
thing had been extravafated into the belly, and which, neverthelefs, the
credible, and expert diffecler denied, upon his oath, having made with the
knife : for that ftomach was, alio, manifeftly eroded, particularly in the
part which is oppofite to the fundus, and had been the ftomach of a man,
(5) Obf. 48. (/>) Tom. 7.
who
Letter XXIX. Article 16. 35
who had a perfect refemblance to a confumptive perfon, and who had died
of conftant vomitings, which no remedy, or art, could appeafe.
Neither was any thing found to have been effus'd, into the cavity of the
belly, by Tyfon (q)y (who is even faid to have found a perforation in the
human itomach, three times) in an American, in whom he found the fame
kind of fillure. I do jiot, here, fpeak of thofe perforations, from which
nothing could have flow'd down into the belly, either becaufe they open'd
into the colon, which was agglutinated, as it were, to the ftomach (r), or
becaufe they were ftop'd up by a part of the liver, which had grown to them
(s). I alfo pafs over thofe cafes, in which it is not faid, whether there was
any eflfufion, or not (/). When there has been an effufion of the contents
of the ftomach, into the belly, I fee that either a very fpeedy death was the
confequence (u), or, at leaft, that frequently it was not delay'd more than a
very few days (*), if we reckon the days of the perforation, from the c'r/
of the difeafe being become very violent, as it happen'd in an obfervation of
the celebrated Baron (y)> which certainly deferves well to be read, who, al-
though he tells us that death did not follow till the eighth day, yet at the fame
time admonifhes, that the foramen was in the upper, and interior, part of
the ftomach, fo that it would have been very difficult for any thing that
was drunk, to be extravafated into the belly, unlefs after fome time, and in
particular motions of the body. And I made ufe of the word frequently, for
this reafon, becaufe I know that fome obfervations are even extant, of the
ftomach being perforated, in which either that is not quite clear (zj, or the
contrary feems rather to appear (a). But you will compare thele circum-
ftances together, and confider them.
16. And although all, or the greater part of, thefe foramina, found in
the ftomach, relate to ulcers, which have fooner, or later, entirely pervaded
the coats of this cavity, yet you have, here, in the Sepulchretum (£), many-
other obfervations of the fame vifcus being ulcerated, both internally, and
externally, notwithstanding fome are repeated, as the letter fifth (for the
fame number five is let down over again, through neglect) in the tony-
third obfervation, article the fourth, and the fixth, in the twenty-feven h,
under article the fecond. But although there are repetitions, alio, 01 o • r
obfervations, that relate to different diforders of the ftomach, as ol that
■which is under number twenty-fix, article the fifth, in the twent) fourth;
there is no repetition that is more worthy of excufe, than where the twen-
tieth is repeated, in the additamenta, under number two. For who wcv'd
have imagin'd that the obfervation which had been propos'd by Blancar-
dus, as if it had been taken from '* a citizen" of his " city" of Amiterdam,
W4S the fame with that which Riverius had already given, as taken from a
(j) Vid. aft. erud. lipf. fuppl. t. 3. f. 4. (x) Earund. cent. 3. & 5. obf. 120. & Se-
(r) Sepulchr. f. hac 7. obf. 13. f. 1. & Brun- pulchr. 1. 3. f. 21. obf. 25.
ner Gland. Duoden. c. 9. & Haller. opufc. (j) Memoir, prefent. all' acad. r. des, fc.
pathol. obf. 23. - torn. 1.
{s) Sect, ead. 7. obf. 5. fecunda, & in addit. (z) Sepulchr. 1. 3. f. 8. obf. 14.
obf. 3. & eph. n. c. cent. 3. obf. 13. (a) Eph. n. c. dec. 3. a. 9. obf. 91. &
(t) In fchol. ad. obf. 3. inodo cit. prime & cent. 1. & 2. obf. 151.
tertio loco, & feft. ead. obf. 7. §. 1. (/>) Adde & fcq. viii. feftionem.
(u) Eph. n. c. cent. 5. obf. 43.
F 2 goldfmith
36 Book III. Of Difeafes of the Belly.
goldfmith of Montpelier •, unlefs any one who, having learn'd the ingenuity of
Blancard,. in transforming hiitories, and remembering a fimilar obfervation to
have been given by Riverius, had compar'd both of them together, and not
only found them fimilar to each other, but had found that they were, very
evidently, altogether one, and the fame ?
But to return to thofe that relate to ulcers, among others, the forty-
eighth deferves well to be read ; for it is my opinion, that if this could have
been extant, a hundred and twenty years before, it would have prevented
Gefnerus, not to mention others, from being fo ready to publifh that which
you have here under number thirty-fix, of lizards for inftance, and ferpents,
being generated within the vifcera, and killing with the permiffion of the
almighty, " about three thoufand men" by the molt cruel pains. For, to
pafs over the reafonings, and admonitions, of our Vallifneri (c), which I
could heartily wifh had been read, and duly weigh'd, by many of thofe
who went on to publifh obfervations of this kind, afterwards, without any
doubt, or hefitation ; at leaft, in that forty-eighth obfervation, alio, which I
juft now quoted, the hiftory of a man, is copied from Hartmann, who
was fo firmly periuaded of his having a lizard in his ftomach, that he made
no fcruple to delineate the figure of it, and another is fpoken of by Lucas
Antonius Portius (d), who afferted that he had a frog in the fame place,
wrhich fometimes croak'd, and if he drank any water, fwam about in it, and
not to uie many words, you will find from Brunnerus (f), that a woman, by
reafon of a biting, and other fenfations, which fhe felt in her ftomach, was
fupposM to nourifli a living animal there. Yet this woman, inftead of her
living animal, and the laft of the two men, inftead of a frog, and the firft, in-
ftead of a lizard, had only tumours of the ftomach, which were, for the moft
part, ulcerated.
I would, therefore, have you add to the Sepulchretum, the two more
modern hiftories, out of thefe three, with their figns, whatever they are, and
their diffections. For there are not only fome others to be added, from the
lefs modern hiftories, as for inftance, that which you will read in Freherus
(f), of the very famous cardinal Baronius, who was deftroy'd by an infupe-
rable naufea, which arofe from three ulcers in the mouth of the ftomach,
but alfo from the more modern in particular, many, as one of Brunnerus
(g), With an ulcerous tumour, as that of Bafterus (&), which is, in general,
not much unlike the former, as two of the celebrated Plancus (;'), both of
a callous ulcer, and others, in like manner, among which are fome of the
celebrated Haller's ; for befides that of a fcirrhous ftomach from the abufe
of vinegar (£), he has two others, one of which (/), defcribes many tuber-
cles therein, full of pus, the other (;»), defcribes the ftomach, as bein»
extremely deform'd with fcirrhi, and abfcelTes, betwixt the membranes,
(c) Confideraz. int. alia generaz. de' vermi. (/) Epift. ad. put. a. 1726. & epift. ad eund»
(d) Vid. aft. lipf. a. 1704. m. Septembri. de monitr.
(f) Gland, duoden. c. 9. (k) Opufc. pathol. obf. 21.
(f) Theatr. viror. erud. clar. p. 1. f. 2. (1) Ibid. obf. 22.
(g) C. 9. cit. (m) Ibid. obf. 23.
(/->) Aft. n. c. t. 8. obf. 16.
where
Letter XXIX. Article 1 6. 37
where it adhered to the colon, with which it communicated, by means of
an ulcerated paffage that lay open.
For, as you read over, attentively, all theft obfervations, beginning with
that of" Hermannus, and adding another, moreover, of the celebrated Gorit-
zius («), you will readily obferve, that there are but very few, in which.
there was not an injury, either in the pylorus, or near the pylorus-, fo that
for this realbn, alio, the opinion of Frederic Hoffmann (0), may teem to be,
for the molt part, at leaft, not very abfurd, or contrary to truth, I mean that
the pylorus is primarily, and principally, affe&ed in a cardialgia, especially,
as in the next, and eighth fe&ion of the Sepulchretum (p), we read that the
ftomach was internally corroded, alio, near to this orifice, and in this (j), that
the orifice, itfelf, was not only very much fwell'd, externally, and had vo-
micae fill'd with white pus, but was likewife fcirrhous, on [ the internal fur-
face, and befet with whitifh, and indurated glands,, more than the other
part of the ftomach.
Moreover, as you fee that in the obfervations, which I have quoted from
Hermannus, and Bafterus, either glandular, or fungous, excrefcences of the
pylorus were join'd, in fuch a manner, with ulcers, of this part, that they
might be fuppos'd to have grown out from the ulcerated fubftance of the
pylorus itfelf; you will without doubt, enquire, whether the other excref-
cences, which other perfons, and I myfelf, alfo, have fometimes feen, both
at this, and at other parts of the ftomach, are all of them to be fup-
pos'd to have proceeded from fome ulcer of that vifcus ? For you fee, by way
of example, in the additamenta to this fection (r); that two verruca, or warts,
were oblerv'd by Paulinus, in the ftomach, about the left orifice, " adher-
" ing firmly together with their roots," one of them of the fize of a fmall
apple, the other of the fize of a pretty large filbert, but that no mention
is made of any ulcer, from whence they arofe ; although, fome time before,
a mafs, equal to the fize of an acorn, had been thrown up by vomiting,
with a large quantity of blood : and indeed we generally fee warts upon the
fkin, externally, without any ulcer.
But, as to what the Arabian Phyficians have written, upon warts of the
ftomach, you will read it in Marcellus Donatus (j), and you have it in part,
alfo, in the fcholium to the appendix, which is fubjoin'd by Bonetus, to the
thirteenth obfervation of this fection : although as the wart, which is there
fpoken of from Avenzoar, was of the bignefs of an apple, it is not eafily
underftood, how it was poflible for it to get out of the ftomach, and be
thrown through the fmall inteftines, into the large inteftines •, fo that it is
very natural to fufpedl this excrefcence not to have been generated in the
ftomach, but in that part of the colon (/), which is contiguous to the fundus
of the ftomach, efpecially as vomitings are never faid to have been ob-
ferv'd in that patient, but, always, ftools of a morbid appearance, fome-
times bloody, and fometimes of various colours.
(«) Eph. n. c. cent. 8. obf. 20. (q) In Addit. obf. 6.
(0) Commerc. litter, a. 173 1. fpec. 44. in \r) Obf. 5.
fin. (s) De med. hid. mirab. 1. 3. c. 5.
(£) Obf. 4. (/) Vid. etiam epift. 31. n. 21.
17. How-
38 Book III. Of Difeafcs of the Belly.
17. However in regard to what the Arabians have call'd wart', which, if
they were not polypi of the interlines, or of the ftomach (of which kind
nearly, I fhould fuppofe that flemy fubftance to have been, that is de-
fcrib'd to have been thrown up after many vomitings of blood, in the appen-
dix, of which I fpoke juft now) might be flefhy excrefcences, as the vermes
of Paulinus might alfo be, which in fome meafure refembled warts, that
were pendulous from a root j if you choofe to fuppofe that thefe ow'd their
origin to a kind of ulceration, or erofion, I (hall not be repugnant to your
opinion. But I will rather enquire, whether you are to fuppofe the lame
thing of fome others, as for inftance, of that pretty large glandular caruncle,
which was fix'd to the ftomach, near the ring of the pylorus, by an oblong
italk, or radicle, which, as it is defcrib'd by me to you, in the fixteenth let-
ter («), you may compare with that which is given in the Sepulchretum,
from our Prasvot (x), which is faid to have been annex'd to the fame part of
the ftomach, by an oblong membrane, and was, I fuppofe, like mine, in this
circumftance alfo, that it was not injurious.
For although it is thus faid thereof in the Sepulchretum, " this body
" falling into the pylorus, without doubt, all the exit of the chyle might
" have been entirely prevented, and various fymptoms might have arifen •"
this exit is not, therefore, faid to have been prevented, or thefe fymptoms
to have arifen ; fo that it by no means appears, why this title was prefix'd to
the obfervation, " a confumption from, a glandulous caruncle adhering to
** the pylorus." To me, I confefs, excrefcences of this kind, which are leen to
hang pendulous from the (kin, in fome perfons, and are numbe*'d, by
fome, among the marks of the mother, feem to have almoft a fimilar origin,
which does not relate to ulcers.
Yet I would not deny, but it may poflibly happen, that from accidental
injuries, thefe marks may be broken, and ulcerated. So in one or two
perfons, and particularly in an old man, whom I fhall defcribe to you here-
after (y), among thofe who died of a blow on the head, I faw a kind of
membranous flap, or fold, hang from the ring of the pylorus, in a lacerat-
ed ftate, fo that you could not doubt, but it had formerly been larger, nor
was it as yet quite found on the extremity of its edge. There are alfo,
other verruae taken notice of by me, in the fame ring, not pendulous, but
feflile, or dwarfim, as it were, as in a porter, whom I fhall fpeak of hereaf-
ter (2), as having fallen from a houfe, and broken almoft all his ribs, and,
in like manner, in an old man, of whom I (hall make mention (a), when, in
treating of the gonorrhoea, I touch upon the diforders of the proftate gland.
For in both of thefe bodies, two roundifti corpufcles, of the bignefs of a
vetch, adher'd to that ring, in the firft of them, fomewhat livid, in the fe-
cond, of a red colour, and in both of a glandular fubftance. And indeed
in ihe fecond, they difcover'd, each of them, their feparate little foramina,
though in a fomewhat obfeure manner, which we could fee in a more large,
and more clear ftate, in the neareft lenticular glands. For thefe this man
had very much enlarg'd in their fize, in the continuation of the antrum
(u) N. 36. (2) Epiit. 53. n. 37.
(x) L. 2. f. 7. obf. 138, \a) Epiit. 44. n. 19.
00 Epiit 52. n. 8.
pylori,
Letter XXIX. Article 18, 19. 39
pylori, through which, two or three prominent lines were drawn longitudi-
nally, and terminated in thole two round ifh tubercles : and upon each of
thefe lines, two or three glands adher'd, being disjoin'd by fome little in-
terval.
Thefe lenticular glands, of the flomach, call back to my mind, another
obfervation thereof, that relates particularly to this occafion, as it was not
taken from a man, in whom no figns of a diforder in the flomach had exifl-
ed, which, to the beft of my knowledge, there had not been in thofejufl now
taken notice of, but from one who was taken off by fliort, indeed, but very
violent, pains of the flomach.
1 8. A man of forty years of age, of a mufcular habit, and much given to in-
tenfe thinking, had, for fome days paft, .been troubled with a pain in the
head, and a lenfe of heat in making water, when after a fupper, in which
he had neither eaten too much, nor any thing that was unwholfome, he was
feiz'd with violent pains in the region of the flomach. The pain of his head
continued. Thofe of his flomach were encreas'd. A great quantity of green
matter was difcharg'd by the inteflines, and by the mouth. And with thefe
fymptoms, he died at Venice, on the beginning of the third day, which
was in the middle of Augufl, in the year 1707.
When the flomach was open'd, the right part of it was found : and there-
in I faw, in conjunction with my learned friends, a great number of lenti-
cular glands, in the manner I have defcrib'd in the third of the adverfaria
(b). The left fide of this vifcus was mark'd, in its fundus, with bloody
fpots, and thefe of a lively red : among which, fome that began to be co-
ver'd over with an ugly ferruginous little cruft, fhow'd that the diforder had
already inclin'd to a gangrenous flate. On the fame fide, where there were
no fpots, and where the internal coat feem'd to be found, I could eafily prefs
out the blood. The duodenum, and the reft of the inteflines, even when exa-
min'd internally, had no appearance of difeafe. The gall bladder was contracted
at the diflance of two, or three, inches from the lower part of its fundus, and
was again dilated, before it terminated in a cyftic duel:, fo that it might feem
to be divided into two veficles.
The lungs adher'd, by means of their own fubftance, to all the parietes
of the thorax, being connected in the fame manner alfo, to the mediaftinunv,
they were found however -, for as to their being red, on their pofterior part,
the back, and the pofterior parts of the arms, were ting'd equally of the
fame colour. Nor was there any blood, either in the heart, or in the auri-
cles. In the other parts, all of which I examin'd, except the brain, there
was nothing wcrchy of remark.
19. No great error, or irregularity, in point of living, had been committed by
this man, as had been by him, whole flomach the celebrated Koehlerus (V) found
to be irflam'd, and befet with black fpots : there was not the leafl fufpicion
of a medicine which had been of a nature not fuitable to his flomach, as
was the cafe in the hiflory given by Klaunigius (d), or as you read, more
(b) Animav. 4. (d) Eph. n. c. cent. 3 £4 obf. 145.
ft) Commerc. litter, a. 1743. Hebd. 5.
a. 2.
than
40 Book III. Of Difeafes of the Belly.
than once, in this fedtion of the Sepulchretum, of poifon being either frau-
dulently, or accidentally, given. And fome things had even preceded, as
you might have obferv'd, which feem'd to difcover a confiderable acrimony
of the blood. Yet if you fhould happen to be furpriz'd at any thing, in this
hiilory, you will ftill more be furpriz'd, in that of a woman, which I have
already promis'd you (<?), and will at prefent give you.
20. A poor country woman, to appearance about fifty years of age, had
been fubject, at intervals, to a difficulty of refpiration, join*d with a fenfe
of ftreightnefs, a hard pulfe, and a violent agitation of all the arteries, fo
that the alternate motion thereof, fell under the notice of the eye, even in
her very hands, and not only in the neck, and the temples. When her re-
fpiration was extremely difficult, fhe came to this hofpital, and having loft
a large quantity of blood, which was fomewhat hard in its confidence, fhe
was freed therefrom. Thus fhe liv'd four years, when being feiz'd, at
home, with pains of the ftomach, fhe died there, within four and twenty-
hours.
Her body was given to me, that I might teach anatomy from it in public,
before the latter end of January, in the year 1737. As we examin'd every
part in its order, thefe things feem'd worthy of remark, in the belly. The
ftomach was large, and half-full, and when we came to open, and examine
it, we were furpriz'd that the contents had not been thrown up by vomiting.
For it was ulcerated with many, and various erofions, which feem'd recent,
and were already affected with a gangrenous blacknefs. Some of them were
very thick, and very fmall, at the upper part of the ftomach, fome of which
kind were, alfo, feen in the neareft part of the duodenum : others were at
a greater diftance from each other, and larger, in the fundus, and more fo,
where the ftomach began to expand itfelf from the termination of the cefo-
phagus : nor was the cefophagus, itfelf, free from erofions of the fame kind ;
fo that they feem'd to have been caus'd by the food which had been taken
in, though of what kind this food had been, there was no certainty, nor
could we form any tolerable judgment, from the matter which remain'd in
the ftomach.
The fpleen was fomewhat larger than it naturally is, and more lax, being
connected, in tie greateft part of it, to the diaphragm, and in fome part of
it, to the ftomach, which it is pofiible might ariie from the encreas'd magni-
tude thereof. The uterus was very much inclin'd to the left fide-, and for
that reafon the round ligament was much fhorter on the left fide, than on
the right. To one fide of the cervix uteri, internally, a membrane of a pyramidal
form aclher'd, that had its upper part flatten'd, being fmall in its fize, thickifh
and white, which I judg'd to be the remains of an hydatid, that was former-
ly diftended with water. The urinary bladder, quite from the orifices of the
ureters, fhow'd the fanguiferous vefiels very confpicuous by their rednefs ; fb
that notwithstanding they were very minute, the communications of one
with the other, could not have been- more clearly feen, if they had been fill'd
by an injection of red wax. In this manner they were continued, in very
great number, on both fides, into the urethra, the internal furface of which
(0 Epift. 14. n. 35.
was
Letter XXIX. Article 21. 4^
was taken up with them in a ftill greater degree •, but, for this rcafon, they
were not quite fo beautiful as in the bladder.
In the tlifll-clion of the meientery, which abounded with fat, and that of a
very good colour, and confidence, as the other parts did likewife, more than
you would have fuppos'd from firit fight, I law glands which were found in-
deed, but much bigger- than ufual, as many of them were even equal to beans
of the largeft iize. The beginning of the fuperior mefenteric artery was
common alio to the cceliac. The coronary of the ftomach had a much larger
diameter than ufual. But the vena cava, while it was cut through, above and
below the liver, as is the cuftom in anatomical theatres, did not pour out a
fingle drop of blood.
Both cavities of the thorax had a little water in them, which was ting'd
with no colour at all : the lungs were turgid with air, and connected to the
pleura, on the back-part, and on the fides. In the heart, and in the jugular
veins, in which there was a larger quantity of blood than in the inferior
veins, was fome appearance of a polypus. The parietes of the heart were,
evidently, much thicker on the left fide, than they ought to be, whereas, on the
right fide, they feem'd to be thinner than was natural. Yet there was no di-
latation or" the ventricles, or of the veins, or of the pulmonary artery, or,
finally, of the trunk of the great artery. There was, indeed, fome what of
a hardnefs in the valves thereof, and in the trunk itfelf, both near the heart,
and in other places up and down, in like manner, which were the marks of
oflifications, that would have taken place, if the woman had liv'd longer,
though difcover'd, at prelent, only by a kind of yellow colour, and were even
already grown very hard, a little above the diaphragm, where they were larger,
and more protuberant : but the trunk was, every where, of its proper dia-
meter.
Yet it was not fo in all the branches of that trunk. For befides that co-
ronary, of which I have fpoken already, when I compar'd the carotid
arteries one with another, a greater breadth was evidently to be feen, in that
on the left fide, than in the other. And as the left of thele arteries, afrer
having fcarcely mealur'd out an inch and a half in length, from its origin,
was divided into two branches, by a very extraordinary inflance, it was fome-
what more dilated, where it began to divide, than arteries are accuftom'd to
be, in moft perfons, at their distributions : and the fame thing I obierv'd,
at the firft divifion of both the fubclavians, into the larger branches.
At length, having open'd the cranium, on the twenty-eighth day, after the
woman's death, the brain was not only without any morbid appearance, but
had even no difagreeable fmell, nor was found, in any rerpect, worfe than
others, that I diiTected at the fame time, which were much more frefh.
21. In the thicknefsof the parietes of the heart, on the left fide, being pre-
ternaturally encreas'd, you have a part of that caufe, which fo violently agi-
tated the arteries, and in the feveral dilatations of thefe arteries, and the
many beginnings of offification, the effects of the fame agitation : all whi h
circumftances, you may compare with thofe things that I have already laid
upon the fubject of fpurious aneurifms, as Lancifi call'd them (/).
(f) Epift. 24. n. 35. & feq.
Vol. II. G You
42 Book III. Of Difeafes of the Belly.
You have, moreover, which particularly relates to the prefent purpofe, the
caufes of a mod fevere pain of the ftomach, in the erofions of that vifcus.
And a; I alfo found erofions, pretty fimiiar to thefe, in a fhort time after,
in the ftomach of a drunken man, delcrib'd in the fourteenth letter (g) ; to
omit thofe appearances, which I defcrib'd juft now, as having been leen, by
me, in that Venetian (b) ; I am much in doubt, whether to attribute them
all to I know not what kind of food, that was taken in, or rather to fome
poifonous juices generated internally. Yet though I might perhaps do this,
with fome degree of colour, in one of thefe hiftories ; it feems, however, lefs
poffible to fuppofe it in the laft, in which the pafage to the ftomach, that is
the cefophagus, was alfo befet with the fame erofions.
But in regard to the effects of poifons, obferv'd in the ftomach, by means
of difiection, as I fhould rather chufe to treat of them, at once, in their
proper place, than here and there irregularly, as I fee is done in the
Sepulchretum-, I {hall, for this reafon, refer to that proper place (z), whac
I forbear to add at prefent : as for a like reafon I fhall alfo defer to another
occafion, thofe things which relate to the pain of the ftomach, from a confer: z
with other parts, and particularly with the kidnies.
22. But in regard to thofe pains of the ftomach, which arife neither from
poifon, nor are produe'd from caufes that lie on the outfide of the ftomachr
if you enquire after fuch things, as you may add to thofe you have read
above ; 1 think you ought to add, in the firft place, the obfervation of the
illuftrious Heifter (£), in which he defcribes a moft violent cardialgia, brought
on by a great heap of worms, which had fo injur'd the ftomach, about the
left orifice, where he found them adhering, that it was bloody, and, in a
manner, eroded : and this in an adult woman •, not in children, in whom it
is lefs furprizing, that almoft fimiiar appearances were found by Bonetus,
and by our Saxonia, as you have it in this fection of the Sepulchretum (/).
And although many examples (m) are given, in the fame fection, of a pain
of the ftomach, from calculi, that were form'd therein ; yet you may add
frefh examples from Lanzonus (»), from Contulus (o)t and others. Fare-
well.
<g) N- 34-
(A) N. 1 8.
(/') Epift. 59. n. pnefertim 21.
\i). Eph. n. c. cent. 5. obf. 86,
(/) Obf. 14.
(m) Obf. 29. 31. & 32.
(a) Aft. n. c. t. 1. obf. 64.
{0) De Lapidibus, podagra, &c. c.
LETTER
Letter XXX. Articles i, 2. 43
LETTER the THIRTIETH,
Treats of Vomiting.
1. TT T I T H the pain of the ftomach, which was treated of in the former
V V letter, is frequently join'd vomiting, of which I am to write at pre-
fent. And this you may obferve, not only by reading the laft letter ; but
alio by turning over the eighth feclion of the Sepulchretum, and comparing
it with the feventh. For you will find many obfervations, in which both of
thefe fymptoms are defcrib d, and not a few which are equally deicrib'd in
both lections.
We however mail keep fteadily to our former refolution, and fliall not pro-
duce any one of thofe here, which we have either given already, or are to
give hereafter. I felect, therefore, out of all theie of Valfalva, two only •, one
relating to a long-continued, the other to a fhort vomiting, but both of them
to a vomiting which had fatal events. The firft of thefe obfervations is as
follows.
2. A man of about fifty-four years of age, had begun, five or fix months
before, to be fomewhat emaciated, in his whole body, when in the begin-
ning of the month of Auguft, of the year 1689, a troublefome vomiting
came on, of a fluid which refembl'd water, tin&ur'd with foot. . And the -
fame kind of fluid was difcharg'd by ftool, fometimes, when the vomiting
was upon the patient, and, fometimes, when it was abfent, but this dis-
charge was not conftant. Tn the mean while, fcarcely any pain was per-
ceiv'd, in the region of the ftomach. But the phyfician having prefcrib'd
fait of wormwood, it created fuch uneafinefs in the ltomach, that it was ne-
ver given afterwards. At length the vomiting being very violent, with a
difcharge of the fame matter, and the pulfe growing, by degrees, very lan-
guid, death took place of life, on the thirteenth of November.
All the limbs of the body were flexible : which does not often occur in
other carcafifes. In the ftomach, towards the pylorus, was an ulcerated can-
cerous tumour, and this feem'd to be made up of a congeries of glands,
which, being prefs'd, difcharg'd a kind of humour, like the male femen
And the ftomach contain'd three pints of a matter, almoft of the fame nature
with that, which was thrown up by vomiting. Betwixt the ftomach and the
fpleen were two glandular bodies, of the bignefs of a bean, and in their
colour, and fubftance, not much unlike that tumour which 1 have deicrib'd
in the ftomach. Thefe were the appearances in the belly.
And in the thorax, the right lobe of the lungs was fomewhat inflam'd
on the pofterior part : but ferum iflued forth from both of the lobes, in eve-
G 2 ry
44- Book III. Of Difeafes of the Belly.
ry part, when cut into. From the right ventricle of the heart, polypous
concretions went into the pulmonary artery : and a fmall one from the left,
into the pulmonary vein.
3. If you compare, one with another, the two tumours of the ftomach, I
mean this, and that which I alio defcrib'd from Valfalva, in die former letter.
(a), both of which he call'd by the name of cancer, in the fliort references
to his obfervations, and has faid that both of them had a vomiting attend-
ant upon them, by which a fluid, like water ting'd with foot, was dif-
charg'd ; you will perhaps wonder why the former occafion'd fuch fevere
pains, and this fo flight, and why this, as, when prefs'd, it gave out a hu-
mour that was not fuliginous, could, neverthelefs, be able to tinge fo great a
quantity of humour, with that colour. But that a very black matter has
been thrown up, even by thofe who had no tumour of this kind whatever,
you will not only perceive from the obfervations of others, but alfo from
one of thofe which will be given below, fo that it is by no means neceflary
to account for colours of this kind from cancers of the ftomach, that are
become ulcerated.
As to that difference of pains, however, unlefs you account for it, in the
firft patient, from the humours being more irritating, than in this, as the
firft was a pretty old man, and of a bilious temperament, although in the
]aft, the pains became very troublefome, by the taking of fait of worm-
wood ; you will conjecture that there had been flight pains in this latter pa-
tient, at firft, juft as there were in the former, but that after the tumour was
fo irritated, by the fait of wormwood, as to be at length ulcerated, they
not only became more violent, but continued to the very clofe of life.
4. A nobleman of two and forty years of age, having come out of Ger-
many into Italy, was feiz'd a few months after, with a double tertian fever,
at Bologna, which was attended with pretty mild fymptoms, in its firft
accefTions ; but in its fourth accefllon was very violent indeed. For the cold
fit, which began about the twentieth hour, did but juft remit at the third
hour of the night : his thirft was very troublefome, his tongue rough, his
breathing difficult, he felt a laflitude, had a fmall and weak pulfe, a pain,
and fenfe of fulnefs, in the ftomach, and, finally, fo great was his reftleflhefs,
and anxiety, that he fcarcely remain'd two minutes together, in any one part
of the bed.
All thefe fymptoms continued without any remiflion, till, the heat coming
on more violent, the patient had leave to drink a draught of diftill'd waters,
when they began to abate-, but they abated only a little, and for a fhort
time. For foon after all the fymptoms were again exacerbated, and continued
violent, through the whole night. Early in the morning he found that he
had a vomiting coming on : but, at firft, he could not excite it even by
thrufting his fingers into his fauces ; yet foon after, he threw up a fluid to
the quantity of four pounds, and this fluid was like water, in which cho-
colate has been difiblv'd. In this humour floated fome fmall portions of
membranes, as it were, which had the very fame colour: and the odour of
it was of the fame kind with that which generally exhales from the bodies
of patients labouring under fevers.
(«) N. 6.
Though
Letter XXX. Article 5. 45
Though the diibrder of the ftomach feem'd to be fomewhat alleviated by
this vomiting j yet the other difagreeable iymptoms not only continued, but
were even more violent than before. In the morning the phyfician order'd a
a vein to be open'd, and fome blood to be taken away, and the blood, in the
firft cup, fhew'd a crafiamentum that was fofter than it naturally is, a thin
cruft on the upper part; and a milky ferum around •, but in the fecond, all
thefe feveral parts of the blood receded leis from their natural ftate. This and
other remedies being made ufe of, after a few hours, almoft as much as be-
fore, of the fluid I have defcrib'd, was thrown up by vomiting : and the
fame thing happen'd again, and again, a little time after-, fo thac the whole
of the quantity, which was thrown up in this manner, on that day, was equal
to about fixteen pints.
The night following, the fame Iymptoms were violent, a tremor of the
left arm coming on befides ; which had a delirium preceding it, and often
recur'd, but particularly while the arm was expos'd to the air : and in the
morning, degenerated into a kind of epileptic paroxyfm, in which, not only
the arm, but the mouth, the eyes, and the left thigh alfo, were extremely
convuls'd. Thefe iymptoms lafted for a great number of hours: at length,
that arm was ieiz'd with a palfy. Neverthelefs, the epileptic attacks conti-
nu'd to return fo frequently, that more than twenty were reckon'd within
an hour. In the mean while, the vomitings were alfo more frequent, by
which a matter of a porraceous colour was difcharg'd, and in this matter
fragments offmall membranes, as it were, floated.
Moreover, a fingultus, which had begun after the palfy I mentioned,
about noon, began now to be much more violent. And, notwithftanding all
thefe iymptoms, feem'd to be fomewhat more quiet after dinner, yet, when
the evening came on, they were again exafperated ; fo that the pulfe, and
the ftrength, being more and more decreas'd, through the whole night, and
the patient, being troubl'd with gentle vomitings, at one time, at another
time, with the delirium, and fingultus, but ftill more often, with dreadful,
though Ihorter, fpalmodic paroxyfms, died at the twelfth hour in the
morning.
The abdomen was tumid, as the inteftines were alio. Thefe, and the fto-
mach, on their more anterior furfaces, were ting'd with that fame colour,
with which I faid the fluid had been ting'd, that was thrown up by vomit-
ing. The ftomach was internally inflam'd, all the fmall veflels whatever be-
ing very turgid with blood. The gall-bladder, although empty of bile, was
neverthelefs feen to be very turgid, but this turgidity, was from air.
In the thorax, the right lobe of the lungs adher'd clofely to the pleura :
and this, and the left, were ting'd with a black colour, and full of an ichor-
ous matter. In the right ventricle of the heart was a flender polypous con-
cretion.
5. The fatal event, which was indicated by the fourth day in this gentle-
man, was finally brought oi<, by the feventh. But if before fo great an im-
petus of the diforder had fallen upon the ftomach, the phyfician, whoever
he was, lufpectingfrom lome difcoveries of the former days, what was at hand,
had made an early, and proper ufe of the peruvian bark, he might, perhaps,
have been able to prevent the progrefs of the diforder, and thus have iav*d
the
46 Book III. Of Difeafes of the Belly.
the patient. But thefc things happen'd, as far as I can gather from this, and
the preceding obfervation, at that time, in which they were as yet afra-d of
ufing the peruvian bark, by way of a febrifuge, in the manner that we ufe
it at prefent, and as it was firft made ufe of at Bologna fuccefsfully, a few
years after, by that very ingenious phyfician Dominic Gulieimini, in the
cafe of a gentleman of a noble family, whom the next exacerbation, of a
dangerous fever, would otherwife have carry'd off, as it had happen'd to
others.
However, from whence the porraceous tincture arofe, with which the hu-
mour thrown up was colour'd, is mown by the emptinefs of the gall-blad-
der. But other juices were mix'd with the bile, in the ftomach, and inte-
ftines, before, when the fluid, which was thrown up, had quite a different
colour. But with which of thefe colours thofe vifcera were ting'd, as Valfal-
vahas not made it fufficiently clear in his papers, I was not at liberty exprefs-
ly to determine, in the hiftory.
6. But now I will give you other hiftories, which are likewife divided into
two kinds, the one relating to vomitings of a long continuance, and the
other to thofe of a fhort continuance. And of all thefe, that fhall be the
firlt, which produces an example of vomiting, than which not many of lon-
ger continuance will be found: and this is the fame that I remember to have
promised you, in particular, when I fpoke of the palpitation of the heart (b).
7. A noble matron of Padua, who, from her very birth, had often thrown
up the milk fhe fuck'd, lb that her nurfe defpair'd of her living-, having
neverthelefs grown up to an age of maturity, was married, and became the
mother of many children, and being now in her thirty-fourth year, began,
in her lying-in, to be frequently troubl'd with a vomiting, from which, after
two months, fhe believ'd fhe fhould be free for the future, as fhe had thrown
up a kind of globular body, more than two inches in diameter, which, at that
time, confifted of a pretty foft matter, but, being expos'd to the air, was,
after three days, found to be extremely hard.
But the event did not fucceed to her wifhes. The vomiting continu'd, and
notwithftanding it was contended with by many phyficians, for a long time,
fometimes by more* mild, and, at other times, by more violent remedies, yet
it continued to the very time of her death, that is for four and twenty years
together. It return'd every day at two hours after dinner. It did not return
after iupper till the next day in the morning. And although changes were
frequently made in the nature of her aliments, it always return'd in the fame
manner, and flie always threw up a whitifh matter, which was thick in its
confidence, and ductile. And if the patient endeavour'd to prevent thefe
vomitings, fhe fuffer'd great uneafinefles in the region of the ftomach, till
they return'd, and the matter was difcharg'd •, but this did not happen with-
out considerable {trainings : however, after vomiting everything was eafy,
and quiet.
There was no difcharge from the inteftines downwards, but by means of
purgative medicines : and this could be eafily brought about, at any time,
without any injury to the patient, by a particular remedy, that is by St.
(/») Epift. 23. n. 21. in fin.
Fufca's
Letter XXX. Article 7. 47
Fuica's pills, as they call them at Venice, a few of which, being kept on the
ftomach at night, gently mov'd the Bowels, as they generally do, but fcarcc-
Jy brought off any thing, befides watry discharges. Chocolate alfo ftaid on
the ftomach, and was of" ule to it. It' you cxamin'd the region of this vifcus
with your hand, you perceived nothing there that was preternatural, nor yet
in the other parts' of the belly. To theie fymptoms that I have related, was
added, about two years before her death, an intermifTion of the pulfe. Yet
the patient did not ceafe to perform the accuftom'd duties of life, both
at home, and abroad ; till finding that fhe was not quite lb well, and grown
weaker, fhe was under a neceffity of palling the laft month of her life in
bed. And there, every thing being now naufeous to the ftomach, and
amonoft others, chocolate alfo, a fever was obferv'd, which encreas'd every
day in the afternoon, and augmented the nocturnal heat, though it made but
little change in the pulfe. The puliation of the arteries was rather large,
but according to cuftom intermittent. As fhe was extremely coftive, fhe
beg'd of her pl.yfician, that he would fuffer her to take the ufual remedy,
that is the pills of St. Fufca ; by which a very great palpitation of the heart
was brought on : and notwithstanding this was alleviated, almoft immediate-
ly, by taking away a few ounces of blood, from the arm, yet it foon after
grew more violent again, and oblig'd the phyfician to order as many ounces
to be taken from the foot, by which it was again diminifh'd, yet not to fo
great a degree, as to fuffer her to lie down on the left fide afterwards.
There was no crufl upon the top of the blood, that was taken away. Some
days after, the patient being again coftive, a gentle glyfter brought on the
palpitation. As external remedies were of no ufe againft this diforder, and as
but few internal remedies were admitted of, by the circumftances of the pa-
tient, who took fcarcely any nourifhment, and that unwillingly, among which
remedies were the diftill'd cherry water, and baum water, and a water made
from compofitions, wherein was a little caflor, to which was once added a
grain of opium, and there being nothing that either prevented the vomiting,
or appeas'd the palpitation, the pulfe growing very weak, (lender, and creep-
ing, on the laft five days of her illnefs, and the palpitation continuing, ftools
came on without any means having been us'd to excite them, and that even
to excefs, fo that they were frequent, and in great quantities, but at the fame
time, however, hard. Wherefore, the other fymptoms continuing, and
the extreme parts of the body growing cold, this very worthy matron ceas'd
to live any longer, I fay very worthy, on many accounts, but even for this one
inftance of her humanity, and virtue, fhe deferv'd to have enjoy'd a much
longer life •, I mean becaufe fhe gave orders, in her laft moments; which ve-
ry few women have the virtue and refolution, to do ; that her body fhould be
open'd, in order to find out the caufe of her obftinate, and long-continued
vomitings, that if it fhould chance to be found out, it might be of fome ad-r
vantage to her children, againft an hereditary difeafe ; for fhe had a daugh-
ter, who already began to be affected with the fame diforder, and her mor
ther, who had been dead many years, had alfo labour'd under the fame
fymptoms of vomiting. . Being therefore defir'd in the name of the noble fa-
mily, by my molt refpedtable collegue Vallifneri the younger, to be prefent
at the dufe&ton, and having heard all the relation that I have given you, from
4 that.
48 Book III. Of Difeafes of the Belly.
that very eminent phyfician Peter de Marchettis, grandfon of Peter the Che-
valier, who had attended this matron, for the laft twelve years of her life,
and treated her with the mildeft methods of cure, as it was proper, in her
difeafe, that he mould j I took care, in prefence of him, and other phy-
ficians, among whom was the celebrated Dominic Militia, formerly my au-
ditor, that the diftection fhould be accurately perform'd, on the evening of
the fame day, on which the patient had died in the morning, that is on the
eighth of April, in the year 1744.
The body was emaciated, but not to any great degree, and had no cede-
matous tumour of the limbs. The belly contain'd a conliderable quantity of
yellowifh water : the omentum was furnimed with but little fat, yet cover'd
a great part of the interlines, and was connected to the peritoneum, on the
left fide : the flomach was contracted, and where it began to approach to
the antrum pylori, it was ftill more contracted, fo as to be, in fome meafure,
divided into two cavities, as it were •, however, in the thicknefs, and colour,
of its parietes, if you examin'd it externally, it was natural •, but on the infide,
of a red colour, as if from inflammation. In the ftomach were contained a
part of the water, or broth, that had been laft &ken, and fome pretty thick
portions of that vifcid matter, which was wont to be thrown up by vomiting.
In the pylorus itfelf, and the duodenum, there was no morbid appearance,
befides the colour of the internal furface, which was fimilar to that I have
mention'd in the ftomach.
The pancreas, which was, in other refpects, of a proper magnitude, was
fo white, in every part of it, and when I order'd it to be cut into, confifted
of lobules, fo diftinct, and fo deftitute of moifture, that if they had been a
little harder, for they were pretty hard, I fhould not only have pronoune'd,
that the pancreas was of a fcirrhous nature, but that it was, already, quite con-
verted into a fcirrhus. The fplecn, and the liver, were internally found, al-
though the former, on its whole external furface, and the latter, on its infe-
rior furface, on the right fide, were pale. But the gall-bladder had all its
parietes fo much thicken'd, that I never remember to have feen the like : for
which reafon, notwithstanding it was full of bile, inafmuch as it was in a
perfon, who, for fo many days together, had taken very little nourifhrnent, and
notwithstanding this bile was fo black, as to have ting'd the interior furface
of the gall-bladder with a black colour •, yet the external furface of it was
white. For the fame reafon that I hinted at juft now, in the contraction of
the ftomach, the inteftines, and particularly the fmall ones, were contracted
alfo, to a very great degree, as even that excefiive evacuation, by ftool,
which had fo lately preceded, required. Out of all the inteftines, the apen-
dicula vermiformis alone, was a little more turgid than ufual, and red on
the external furface. In the mefentery, and the other parts of the belly, we
obferv'd nothing that was not natural.
But in the thorax, water was contain'd on both fides, and not in fmall quan-
tities, nor a little bloody. The lungs, in like manner, though in other refpects
found, were connected to the fides of the thorax, by many thick, and pretty
long membranous filaments. The pericardium adher'd, very clofely, to all the
furface of the heart, to that of the right auricle, and of the large vefTels be-
longing to the heart. Neverthelefs, the heart had a proper thicknefs in its
4 parietes,
Letter XXX. Article 8. 49
parietes, and a proper capacity iii its ventricles. Both of theft cavities ■■■
likewife, full of blood, fuch as iffu'd, in great quantity, from the vena cava,
when cut into, black, and in great meafure coagulated, and grumous, but
without even the leait polypous concretion. The valves that are plac'd at
the venous orifices of the heart, although they feem'd to be white, were not
however indurated. But out of the remaining valves, thole that are fituated
at the beginning of the great artery, had their extreme borders not only much
thicken'd, but of a cartilaginous hardnefs. The artery itlelf was in a very
natural Hate, both internally, and externally : nor did any other marks or"
dileale appear in the thorax, befides thofe which I have mention'd. There
was no reafon for us to go through a diff clion or" the head.
8. As to the disorders that were found in the pericardium, and the heart,
how far they may relate to palpitation, and an intermittent pulfe, I have alrea-
dy hinted in feveral places (c). But thofe which were found in the gall-blad-
der, and the pancreas, feem to me to have a reference to the vomiting.
And perhaps I mould think the fame, alio, of that contraction of the ftomach,
by which it feem'd to be divided into two cavities, as it were, if I had not
defcrib^d the fame ftructure to you, in two other women (d), neither of whom
had been fubject to a vomiting, nor yet a woman of princely rank, and others
befides (e)y in whom I remember that the ftomach had the fame appear-
ances.
For it happen'd to me, when I faw this conformation of the ftomach, to
fee it in women, as it did alfo to Valfalva (f) : from whence I began to fufpect
whether thefe appearances might not be reckon'd among the other difadvan-
tages, that they create to themfelves, by compreffing the upper part of the
belly with hard ftays, if I had not obferv'd that the fame thing happen'd to
women of every ftation, and not only in women, but even in men, as has
been obferved by Riolanus (g), and by the very celebrated authors, Hei-
fter (£), and Fantonus (/'). And not one of thofe obfervers, nor yet the cele-
brated Pctfchius (£), and Amyandus (/), who have feen it in women, have
ever mention'd a word of vomiting, in thefe men, or women, though they
might have mention'd it, and indeed fome of them ought, in juftice, to have
mention'd it, if any thing of this kind had been obferv'd.
And though you will find, in this eighth lection of the Sepulchretum, an
obfervation of Blafius (»*), who met with the ftomach double, in a man who
had been long troubl'd with very frequent vomitings, you neverthelefs will
fee, that he did not afcribe the vomitings to this double ftate, but to the
great narrownefs of the foramen, whereby one ftomach communicated with
the other : which kind of narrownefs never was found, in thofe that I have
obferv'd. But if you read this obfervation in Blafius (»), you will find it to
be join'd with another of the fame kind, in which, although there was, not
only a great narrownefs betwixt the two ftomachs, but " a very great and
(0 Epift. 23. 11. 21 & 23 & alibi. (/') De obferv. med. & anat. epiit. 3.
(.7) Epiit. 16. n. 38 & epiit. 26. n. 31. (i) Syllog. anat. obf. §. 84.
(<•) Epiit. 37. n. 28. (/) Vid. commerc. litter, a. 1734. hebd. 25.
(f) Epift. 36. n. 2. in fin.
{£) Anthropogr. 1. 2. C. 20. (m) N. 26.
(<<•) Diff. filt. obf. med. mifcell. obf. 6. (n) P. 4. obf. med. 9.
Vol. II II " ex-
-V uf
50 Book III. Of Difeafes of the Belly.
(live ftreightnefs," the man was neverthelefs, except his being very
r, " in very good health," and confequently not fubject to vo-
mgs.
Yet if you would choofe to fuppofe, that this ftructure of the ftomach, in
the matron whofe hiftory I have now given you, had alio contributed fome-
thing to the production of the vomitings, inafmuch as it had, without doubt,
exifted from the firft formation of the ftomach, join'd with that deprav'd dif-
pofition of the gall-bladder, and the pancreas, which becoming more evident,
as the patient encreas'd in years, brought on an incurable vomiting ; I mail
not violently conteft the opinion with you. And there is not the leaft doubt,
but fo great a thicknefs in the coats of the gall-bladder, render'd it lefs obfe-
quious to the prefiure of the flomach, and the firft inteftines, fo that, proba-
bly, a fufficient quantity of bile was not prefs'd out from thence, and this
bile was likewife vitiated.
And as the pancreas was without any moifture, and inclining to the na-
ture of a fcirrhus, you may eafily imagine, how much lefs juice it muft, of
courfe, fecrete, and how much lefs fit that juice muft be for the purpofes to
which it was intended, and you may, at the fame time, gather, how imperfect
an elaboration of the chyle there muft have been, from the defect of both thefe
humours, and the diforder in the duodenum, and how much grofs, and vif-
cid, matter muft, confequently, ftagnate there, which would irritate the
coats of that inteftine, in fuch a manner, and particularly in the motions, and
agitations, of the body by day, as at length, to ftir them up to an inverted
motion. And if to thefe you are allow'd to add that peculiar ftructure of the
ftomach, which was, perhaps, not quite fo proper to prepare, and act up-
on, the aliments, or at leaft to thruft them on, with fufficient difpatch, into
that inteftine, it will be fo much the more eafy to conceive the caufes of this
very obftinate, and long-continu'd, vomiting.
9. But to fpeak of one of thefe caufes only, for the fake of brevity, that
is, of the difeas'd ftate of the pancreas, you will fee here in the Sepulchre-
turn, befides the fifty-third obfervation, and thofe that follow, others, alfo,
that are pointed out, and that not only above, but in particular below, un-
der numbers fifty-feven (0), and fifty-eight (p), and other numbers ; and you
will find that a vomiting was join'd with the diforders of the pancreas. It is
true, I am not among the number of thofe, who have fuppos'd, that I know
not what difeafes, and even vomitings of blood, are to be accounted for,
from " the pancreas alone" (q) : and I even confefs, that this vifcus has been
found to be difeas'd by me, and by others, without a vomiting -being the
confequence of it. Yet I cannot deny, that diforders of the pancreas have
been ieen, by me, to be join'd with vomitings, and that I have heard from
others of the fame thing having been feen, frequently, by them alfo.
But I fhall have a more convenient opportunity to give my obfervations
hereafter. At prefent I fhall take notice of fome obfervations from others. .
And in the firft place, I heard from a follower of Malpighi, who was, when
living, a learned phyfician at Bologna, and my preceptor, I mean Jacob
Sandri, that he had made remarks upon many diifections of perfons who had
(f) §• 5 • - (/>) §• 2.4. (j) Vid. ibid. obf. 74. in fin.
1 been
Letter XXX. Article 10, ir. 51
been lubjecft to vomitings, and particularly of a humour refembling tob
in its colour •, and that in all thde bodies the pancreas had been in a difeas'd
ftate. And Heraclito Manfred i ; he whole prailes I have already, with ju-
Itice, proclaim'd ; when I return'd to Bologna from Forli, the place of my
nativity, where I had retir'd for fome months, which I think was in the year
1704, related to me an obfervation of his: which I will here communicate to
you ; and that, rather, becaufe it relates to the difcourfe which I have begun
upon the pancreas, than to the order which I promis'd to obferve.
10. A robull man, without any manifeft preceding caufe, was troubl'd
with a continual endeavour to vomit, yet befides his medicines, and his
food, none of which he could retain, he vomited but little at a time, and
feldom, and what he did bring up was watery, and for the mod part bitter.
Befides this, lie was troubl'd with a great third, with a kind of frequent
fwoonings, and, in particular, with a pain, juflr as if he were torn to pieces by
dogs, at. the common boundaries of the thorax and belly: which, if you ex-
amin'd it with the hand, had not the leaft hardnefs, or refinance, whatever.
With thefe fymptoms, and with a low pulfe, he died within the eleventh
day.
The belly being open'd, the liver appear'd to be very large, but found.
The inteftines, likewiie, and the ftomach, were found. And the mefentery,
alio, though not without fome obftruction. But the pancreas was larger than
its natural fize, and univerfally unequal, with roundifh tubercles of a confi-
derable magnitude, and was itfelf alnioft of a cartilaginous hardnefs. In
the thorax was much water, and in the pericardium, a very large quantity,
like to that in which frefh meat has been wafti'd. The heart was very fmall :
and in its right auricle was fomething of a whitifh polypous concretion.
11. The reafon that tumours of the pancreas, unlefs they themfelves are
perhaps large, and the patient very much emaciated, are feldom perceiv'd by
the touch externally, or, at leaft, not without difficulty, arifes from the remote
fituation of the vifcus, and from the interpofition of whatever may lie be-
twixt that, and the hand, and efpecially from the ftomach being turgid with
flatus, or from the liver, as in this man, being much enlarg'd in its fize.
And as, in cafe of this difficulty, Riverius has hinted what figns we may
make ufe of (r), fo he has not omitted, in the number of thefe, fuch as are
to be taken from the pain of the neighbouring ftomach, and from other fymp-
toms. However, the pancreas may excite a vomiting, in many different
ways, as when it irritates the contiguous ftomach, which js of a peculiarly
exquifite fenfe, by its hardnefs, and roughnefs, or, by an encreas'd magni-
tude, prevents it from being fufficiently dilated.
For the difcharge of all the ingefta, by vomiting, is the natural confe-
quence of the impeded dilatation of the ftomach, whether this vifcus be the
caufe of the obftrudtion to its own dilatation, by reafon of its coats being be-
come much thicken'd, and fcirrhous, as in the obfervations of thole cele-
brated authors, Laubius(j), and Haller (/) ; or whether, for the thing comes
juft to the fame, there are other obftacles oppos'd to the dilatation thereof, as,
for in (lance, large fteatomatous tumours, which Verdriefius («) faw lying
(;■) Prax. med. 1. 13. c. 4. (/) Opufc. pathol. obf. 21.
(j) Eph. n. c. cent. 7. obf. 41. (u) Eph. cit. cent. 6. obft 16.
H 2 near
52 Book III. Of the Difeafes of the Belly.
near the ftomach, or that large body, which, as you will read in the very
excellent Heifter (x), was likewife found in the fame fituation, in two wo-
men. And that the vifcera themfelves, which are contiguous to the ftomach,
may alio be obftacles to its dilatation, if they are immoderately fwell'd and
hard, was prov'd fome years ago, by the untimely death of a moft learned
archiater, who was my worthy friend, and whofe incurable vomiting I heard
was owing to the liver, and the pancreas, which, by their bulk and hard-
nefs, comprefs'd the ftomach, that lay betwixt them.
But the pancreas •, to go on to fpeak of that in particular, efpecially as it
is fo eafy to transfer thole things that are faid of this vifcus, to the liver
alfo •, the pancreas, I fay, may excite vomiting, even when it fecretes a
juice, which, either by its acrimony, is troublefome to the duodenum, or by
its inactivity, or any other defect, whatever, is the caufe of a bad concoction
of the aJiments, and confequently, of fome grofs parts thereof being left
behind, to create uneafinefles in that inteftine j or finally, when by the fmall-
nefs of its quantity, it is unequal to the other ufes, and among thefe, to
that by which it moderates the force of the bile, that flows in with it, parti-
cularly when the bile is more acrid than ufual, and prevents it from ftimu-
lating the coats of that inteftine, too ftrongly, and inverting their motion :
on which fubjecl you may, alfo, confult Frederic Hoffmann (y), who fup-
pofes, this to have been the very reafon, why the bile, and the pancrea-
tic juice, are wont to go to that inteftine, by one and the fame orifice, and
why the dogs of Brunnerus, when the pancreas was taken away, died of bi-
lious vomitings. Therefore when the human pancreas is redue'd to fuch a
ftate as to fecrete no juice at all, you fee very clearly how much more eafily
thofe things that I have laid may be the confequence. But a vomiting
may be alfo brought on in -a different manner by the pancreas, that is, if by
its roughnefs, hardnefs, or encreasrd magnitude, it irritates, or preffes upon,
the inteftine we have been fpeaking of (to which it is fix'd by its broader
extremity) in the fame manner as I have fuppos'd of the ftomach.
According to thefe pofitions, or others of this kind, you may, at your lei-
fure, explain all, or the greater part of all, the hiftories that relate to this
fubjedt, and much more thofe which have a diforder of the pancreas, and the
duodenum, join'd together at the fame time, as this that I (hall immediately
fubjoin, which was taken by that very experiene'd diffefter, our Mediavia,
about the beginning of October, in the year 1733, and communicated to
me at the very fame time.
12. A monk, who was noble both in his birth, and his manners, and one
of the holy family of the capuchins, as they are commonly cail'd, was carry'd
off by a complication of diforders, but particularly by a dropfy, and a vo-
miting, when he was in the thirty-third year of his age.
There was fome water under the fkin of the carcafe univerfally •, for which
reafon the feet, alfo, were fomewhat cedematous. But the bdfty was not greatly
fweli'd, nor had it any greater quantity of water, within its cavity, than about
two pints. The liver and the fpleen were larger than they naturally are, and
the former of thefe vifcera was whitiih befides, and hard, and its lobules con-
fv) Epift. dc pilis, offib. p. n. (;) Di(T. de pancreat. morb. §. 4.
fpicuous.
Letter XXX. Article 13. 53
fpicuous. In the ftomach was nothing worthy of remark, if you except a
plexus of two inches in breadth, and four inches in length, made Up of
crowded glands, lefs indeed than a lentil, but furnifh'd with an evident ori-
fice : that plexus was in the bottom of the ftomach, near the antrum pylori.
At the diftance of an inch below the pylorus, the duodenum was black, and
a little below that, was leirrhous. The pancreas alfo was pretty hard.
In both the cavities of the thorax, was a confiderable quantity of water.
The lungs were contracted. The heart was not without polypous concreti-
ons: and one of its valves not without a bony portion. But on the internal
furface of the great artery, from the fuperior branches quite to the etnul-
gents, were beginnings of future oflification. This artery, though in a body
of a tall ltature, was fcarcely thicker than a finger of a moderate fize : and
the other fanguiferous veflfels, alfo, were narrow in the fame proportion.
13. As this great narrownefs of the velTels, and particularly in a body of
this kind, had probably been the beginning of all its' difeafes, fo I do not
doubt, but that the hardnefs of the pancreas, and ftill more of the duode-
num, had been the cauie of the vomitings. For whether that inteftine is
ftreighten'd by comprefiion, as was formerly obierv'd by Riolanus, whom
you will fee quoted here in the Sepulchretum (z), or whether, by reafon of its
coats being fcirrhous, it is not able to conftringe itfelf, the fame effect fol-
lows, notwithstanding the caufes are fo oppofite, that is the ingefta, which
were about to be carry'd out of the ftomach, as they are receiv'd into the
inteftine with lefs eafe, or propell'd forwards with more difficulty, remain,
the greateft part of them, in the ftomach, and being there corrupted, or
heavy, by the very delay itfelf, grow troublefome to the ftomach, and bring
on a vomiting, a very clear example of which has been even produe'd by the.
celebrated Molinelli (a).
The fame thing muft happen, when the pylorus is affected with diforders
of the fame kind. And you have, here, many examples in the Sepulchre-
turn, as in the eleventh and feventeenth obfervations, and the greater part
of thofe that follow, almoft quite to the twenty-fixth, and again in the fifty—
fixth, article the thirteenth, and in the additamenta, obfervations the firft
and eighth •, and indeed in other places, as in book the firft, feclion the ninth,
and not only in the thirty-fourth obfervation, but, moreover, if you attend
to thofe fiibverjions, in the thirty-third. And among thefe that you will read in
this eighth fection, when you come to the twenty-firft obfervation, which is
not far unlike another from Johannes Bohnius (£), and find in that a vomit-
ing of all the food, which was taken in, and death itfelf at length brought
on, within ten days, by the pylorus being ftop'd up, from a fmall piece of.
filver coin, which the patient had fwallow'd down •, it will, without doubt,
make you call to mind that piece of filver coin, which was of a much larger
fize, and which the experiene'd furgeon du Luc (c ) happily diflodg'd from,
thence, and even carry'd quite out of the body, not only by the help cf
other remedies, but, particularly, by the weight of quickfilver, urging it
(z) Schol. ad obf. 23. (b) Eph.n. c. cent. 3. & 4. obf. 121. in
(a) Comment, de bonon. fc. acad. t. 2. p. 1, fchol.
inter medica obf. 1. (<-) Hift.de l'acad. r. des. ft.?,. 1740. obf..
anat. 4.
down,
54- Book III. Of Difcafcs of the Belly.
down, and by means of this lall-mention'd metal amalgamating, as the phrafe
is among chymifts, with the filver, whereby its iize was diminifh'd, notwith-
standing flight pains, at the pylorus, had already begun to appear, together
with an inclination to vomit.
But not to digrefs too far from thefe obftruclions of the pylorus, which are
produc'd by difeafe, and net by accident, befides thofe observations which I
have pointed out in the Sepulchretum, there are others, and thofe not few
in number, which you may add thereto, as thofe, for inftance, that are ex-
tant in the volumes of the Csfarean academy (^), in the Acta Eruditorum
.Lipfienfia (e), in the Commercium Litterarium f/J, and any others be-
fides, amongft the great number taken notice of by the very learned Trille-
rus (g). Out of all thefe obfervations, you will find fome which, at the fame
time, confirm thofe things, that I hinted juft now, when I fpoke of the pan-
creas, and the duodenum, and fome that evenrefer to the letters, which I have
lately fent you. Of this kind are two even of the celebrated Fantonus (b),
that ought by no means to be pafs'd over here.
Nor, finally, am I wanting in obfervations of this kind, although they are
not fo extraordinary as the fecond of his is : one of thefe I have already given
you, in the preceding letter (i), and for that rcafon ihall not re} f at it here :
but another, which I made on the bifhop of Brefcia, I deft r till I gi ve you
thofe that relate to tumours of the belly (k): and a third, that was commu-
nicated to me by Marianus, whom I have elfewhere commended, in which
calculi, and callus, fo clofely fliut up the pylorus, that it could not be per-
vaded, even by mercury, I fhall fend to you when I have receiv'd ^.ht whole
of it. There is one obfervation, which may be produc'd here, without any
great impropriety : it was taken at Bologna, in the year 1703, about the be-
ginning of December, and I purpofely preferv'd it for the prefent occafion,
notwithstanding it agreed, in part, with another fubject allb, as you will per-
ceive by the obfeurity of the pulfe, join'd with the greateft laxity of the
fibres of the heart.
14. A prieft of the famous order of St. Auftin, whofe name was far from
being obfeure, among the number of facred orators, being fomewhat more
than forty years of age, began, after dole ftudies, journeys, and other fa-
tigues, to perceive a kind of tenfion, at the right hypochondrium, and
this fome months before any other fymptom difcover'd itfelf. At length a fre-
quent vomiting came on, four hours after taking food. And other fymptoms
were of courfe added. Finally, in the laft months of his illnefs, the cafe
was as follows.
In the belly was great hardnefs, and in the right hypochondrium very
great hardnefs-, but no pain if you prefs'd upon thefe parts, whereas, on the
contrary, a fpontaneous pain arofe in the other hypochondrium, and that very
violent indeed, at the time the food was about to be digefted. A humour
was fometimes thrown up, which was ting'd with the colour of tobacco, as
(</) Cent. 7. obf. 87. & cent. 8. obf. 20. & (g) DifTert. de fame lethali, &c. §. 29.
cent. 10. obf. 10. & aft. t. 4. obf. 107. & 135. (7>) De obf. med. & anat. Epift. 2. & 3.
& t. 6. obf. 151. (/) N. 6.
(e) A. 171 1. m. fept. ex Dionjs diflert. (A) Epift. 39. r. 21. & feq.
(f) A. 1743. Hebd. 16. n. 2. cumHebd. 17.
v. 2.
it
Letter XXX. Article 15. 55
it were, but the difcharg'd fluid was, at other times, much more brown, and
black, and fometimes, again, of a various colour, and in the grcateft part of
it,- different from thefe: and fome perlbns did not even fcruple to fay, that
'.in v had not only feen mucous concretions, in this ejected humour, but even
that they had obierv'd pieces of real membranes, as it were, fwimming there-
in. Thefe gentlemen, therefore, thought that the patient ought not haitily
to give up the ufe of turpentine refin, as it was the only remedy that the fto-
mach would retain, when all others were thrown up. But pills of aloes, gum
ammoniacum, and vitriolated tartar, as it is call'd, which another phyfician
had propos'd, they difapprov'd •, though the patient himfelf, conceiving
great hope from the effeift of llools, as mod patients do, eagerly defir'd
them. Thefe pills, therefore, being taken, very great vomitings were the
confequence of them, and from that time every thing began to grow worfe and
worfe. For the pulfe which had been before obfeure, was now extremely fo,
and there was a fever like unto a lipyria : and the urine was fuch as it is in a
jaundice. Within a few days, therefore, the feet being fomewhat affected with
an cedematous fwelling, and the pulfe being quite gone, the patient reach'd
the dole of life, without any confiderable difficulty of breathing, or any per-
turbation of mind.
When the abdomen was open'd, the liver was found to be exceedingly
large, full of fteatomata, and of a fubftance lying betwixt them, which re-
iembl'd the thymus when boil'd, white, lobular, and hard. In the gall-
bladder, together with a livid bile, were nine calculi, of different forms from
each other, every one of which, at firft, inclin'd to a green colour, but, af-
ter being dried, became yellow. The fpleen was very fmall, fo as fcarcely to
exceed the fize of that filver coin, which we call a crown. The pancreas
was fo extenuated that it feem'd at firft to be wanting. The ftomach was,
internally, diftinguifh'd with black fpots : in other places it was flaccid, but
in the pylorus it was callous, fo that it could not yield properly, and be fuf-
ficiently dilated.
The vifcera of the thorax were, alfo, flaccid and lax ; fo that the flefh of
the heart could eafily be drawn into pieces, by the hand. Befides thefe ap-
pearances nothing morbid was obierv'd ; fo that there was no extravafation
of any kind of moifture, either in the thorax, or belly.
15. Whether the fpleen happen'd to be very fmall, in this priefl, from the
original formation, as is perhaps the mod probable, or whether the courfe
of the blood being diverted by the hepatic artery, from the fplenic, into the
enlarg'd liver, ' caus'd an extenuation of the fpleen, and of the pancreas, at
the fame time, or finally, whether the bulk of the liver being encreas'd more
and more, together with its weight, and hardnefs, brought on this extenua-
tion ; you plainly fee, that neither the liver could have fufficient afliftance .
from fuch a kind of fpleen, for the fecretion of the bile, nor the duodenum
a fufficient quantity of juice, to attemper the bile, from fuch a kind of pan-
creas. The nature of the bile, therefore, being chang'd, for this reafon,
but Hill more on account of the diforders of the liver, which even the colour
of it, and the calculi that had form'd themfelves in the bladder, demonftrat-
ed, confequently, the chile, and the blood, being chang'd, and the humours
that are fecreted from it, not only in other places, but particularly in the
itomacfh,
56 Book III. Of Difeafes of the Belly.
ftomach, the interlines, and the pancreas, it is by no means difficult, clearly
to underftand the origin of thofe things that happen'd to this patient, but
efpecially of this very great variety of colours, which appear'd in the matter
that was thrown up. For it is not furprizing, if preternatural colours arife
from humours, which recede much from the ordinary appearances of nature;
nor yet, if from the various fecretion, mixture, and delay, of all and of each
of them, in confequence of thole difeafes, and the {trainings to vonit, at
one time thefe colours, and at another time thofe, more particularly, arife.
It is rather furprizing, if at any time, in thofe who have fhown no mark of
,deprav'd fecretions of this kind, a vomiting be fuddenly brought on, of any
juice ting'd with fuch a colour, as you would by no means expect. An obfer-
vation of this kind, is that which was communicated to me by letter, in the
year 171 8, from the fame perfon, whom I mention'd above (/), I mean the
very learned Manfredi. This obfervation, however, relates to vomitings of
fhort continuance, as you will immediately fee.
16. A man, who was by trade a fmith, went out from home in the morn-
ing, with a very flight pain of his ftomach. Which growing very violent
foon afterwards, the patient began to throw up a humour extremely fimilar
to ink, and before evening he died.
The ftomach contain'd two pints of a humour equally black, inodorous,
and grumous. The internal furface of the duodenum was, almoft univer-
ially, and the ftomach, univerfally, ting'd with the fame colour. 1'he ex-
ternal coat of the ftomach, alfo, on that part where it is tum'd towards the
diaphragm, had a very black fpot, of four inches in extent, every way : and
it was furprizing, that the intermediate coats were no where ting'd with
any other colour but that of tobacco, even in the parts thereof, that lay un-
der this black fpot, fo that there they themielves were not black, notwith-
ftanding they were intercepted, on both fides, with a very black colour.
17. This fpot was perhaps of a gangrenous nature. And the only thing
that prevents me from believing the internal blacknefs of the ftomach, and
the duodenum, to have proceeded from the fame caufe, is that humour,
fo exceedingly fimilar to ink, which was found in the ftomach, and in part
had been thrown up, and which was, of itielf, fufficient to tinge thefe vif-
cera, in that manner. And if you imagine this humour to be atra bilis, you
will be the lefs furpriz'd at the patient's death, when you call to mind the
aphorifm of Hippocrates (;;?), who foretells death to any perfon whatever,
who, to make ufe of the tranflation of Celfus (»), " has a diicharge of atra
" bilis, in a recent difeafe, either by vomiting, or ftool."
But from whence could this very great blacknefs arife ? could it be from the
bile, which was of itielf very black, being extravafated into that inteftine ?
For you may fee in the observations of the celebrated Budjeus (0), and Scho-
berus (/>), that the gall-bladder was very large, and turgid with the. fame
blackifh matter, which the patients had thrown up by vomiting. Was the
bile which had grown already blackifh, made lo much the mere black, by
(/) N. 9. (0) Eph. n. c. cent. 1. & 2. obf. 105.
(;/.-) 22. f. 4. (/) Earund. cent. 3. & 4. in append, n. 12.
(fi) De medic. 1. 2. c. 6. c. 1.
fome
Letter XXX. Article 17. 57
fome other humours being mix'd with it, in that intcftinc ? Or was fomc-
thing black alio, added to it by the blood, which flow'd out from the fmall
veflels, that were eroded during the very violent pain ? Take care how you
fuppofe all this humour to have been blood. For a blunder of this kind
could not poflibly happen, to fo accurate, and experiene'd, an obferver : nor,
indeed, was the quantity of the humour difcharg'd, if we fuppofe it to have
been blood, fufficient to have deftroy'd the patient, in fo fhort a fpace of
time. And even Hoffmann himfelf (<?), describing a young man who died
with black vomitings, and (tools, notwithstanding it appear'd in the ltomach,
that many fanguiferous'vefifels were ruptur'd, did not, neverthelefs, account
for his death from the elfufion of blood, which does not deftroy fo fuddenly,
even when greater, but from the putrefaction of the blood infecting the brain :
and in his patient, death had not follow'd within a few, as in the prefent cafe,
but within four and twenty hours, and the matter which, had been thrown up,
and that found in the ftomach after death, were both of them, initead of be-
ing without any fmell, intolerably fcetid.
Nor was the matron of Budceus, nor the merchant of Schoberns, notwith-
ftanding the latter was carried off in much lefs time than the former, fnatch'd
away by fo fpeedy a fate, as the fmith of whom I am lpeaking, and yet they
had vomited up corrupt and fcetid matter, and in fo great a quantity, that
only a little blood remain'd behind in the veflels. But of what nature this
blood was while they were living, not only the foregoing fymptoms, but the
internal gangrenes which were found after death, and other things, clearly
fhow'd. Yet in regard to fuch a kind of blood, that either increafes, more
than others, that black humour, which the ancients called atra bilis, or de-
generates into it, you may read what two very learn'd Archiaters have writ-
ten upon the fubject, I mean Schoberus whom I have already quoted (r),
and the illuitrious Vanfwieten, who is much more full, and clear, upon this
bead (s).
And you will believe that Hoffmann differs from them only about a name,
when you have attentively read the cafe, and direction, of the young man
I have fpoken of, and thofe of a woman foon after (/). For he deduces the
black vomitings, of both thefe patients, and their black (tools, from blood
indeed, but from that which was putrid, and fcetid, and explains the more
fpeedy death of the young man, " in the fame manner as he would that,
" of thofe who are affected with a fphacelus of the external parts only ;"
for the fpirits of the brain, and of the nerves, being infected by a blood of this
kind, " they fuddenly lofe their (trength, and their life." But if there was
any other humour in this fmith, it was certainly the moft pernicious, and of
the molt deftrudtive properties, by whatever name we may call it, or, rather,
it was the refult of fuch a mixture of humours, as may be compar'd with an
in-bred poifon. For it is not in the power of every black juice to bring
on fuch violent tortures in the ftomach, or to fnatch off the patient by fo
precipitate a death : and this you will alfo learn, from the preceding feventh
lection of the Sepulchretum, when you read, that after a pain of the ftomach,
(q) Medic, rat. t. 4. p. 2. f. 1. c. 5. obf. 2. {s) Comm. inBoerh. aph. §. IC91.& feq.pafiim.
(r) Append, cit. c. 2. $. 5. & 6. " {() C. 3. cit. obf. 3.
Vol. II. . I this
5 8 Book III. Of Difeafes of the Belly.
this cavity was found to be " half full of a black juice («)," or that in the
fundus of it was " a matter like ink (*),*' and other things of the fame
kind.
1 8. Mention being made of bloody vomitings, and poifon, you will per-
haps afk me, why I produce no examples of real blood being difcharg'd
by vomiting, nor any inftances of that which is the confcquence of moft
poifons, that are drunk, or fwallow'd •, efpecially as in this eighth lcdlion of
the Sepulchretum, fo many of each kind are produc'd ? But to what time I
defer confidering the effects of poifon, I have declar'd near the latter end of
my laft letter (y). And the obfervations of bloody vomitings, except that
which is given in the fame letter (zj, remain to be given in other epiftles,
and on more proper occafions. And there, perhaps, I (hall not fcruple, to
declare, what we ought to think of the greater part of thofe obfervations,
which, in this fecTion, deduce the blood, thrown up by vomiting, from the
fpleen. For thofe which account for it, as coming from the lungs (a), are
given with fuch a confeffion, at leaft, as gives you to underftand, that they
are not fuitable to this fection : which confeffion, however, is wanting in
that place, where a vomiting of pus is deriv'd from a large vomica of the
lungs (b). There is, on the contrary, where what was a true vomiting, as
fimilar ftools, about the fame time, demonftrated, I mean of blood, mix'd
" with pieces of flefh," or in other words, with polypous concretions, is ac-
counted for, as coming, by divine permiflion, " from the heart, through
" the lungs, and the afpera arteria (c)\" and for what reafon ? why be-
caufe the heart was found to be " fill'd with the fame kind of matter," as
was thrown up by vomiting.
Nor do I imagine you will expect from me, in this letter, thofe obferva-
tions, which, notwithstanding they have a vomiting attending upon them,
properly belong, either to the iliac paffion, and thofe hernias that are call'd
incarcerated, or to wounds of other parts, and in particular, of the fto-
mach itfelf, or to other diforders of Tome of the vifcera, with which the
ftomach contents. For I do not doubt but you clearly underftand, to what
occafions all the obfervations of this kind ought to be defer'd : and indeed
you will obferve, that moft of the obfervations of this kind, are produc'd in
iuch a manner, in this fection, that we are exprefly refer'd to other feclions,.
where they are copied more at large. But befides a pretty great number
of thefe, others may alfo be addsd, that are fet down twice over in this
feclion : and this you will perceive, by comparing the twenty-ninth obferva-
tion, with article the fifth of the fifty-ninth, the thirty-eighth, with the forty-
third, article the firft, and the fifty-feventh, article the ninth, with the fixth
of thofe you read in the additamenta, and perhaps others •, and you may
fuppofe the fame thing to have been faid of the fcholia, in which obferva-
tions are repeated, as thofe that are l'ubjoin'd to the firft, and the third, will
fhow, if compar'd with the fcholia added to the thirteenth, and, in like man-
ner, to the fifth i and perhaps the fame may be remarked of others.
(u) Obf. 23. (a) Obf. 75. §. 1. & 2.
(x) Obf. 26. §. 1. (l>) Obf. 65.
(y) N. 21. (<r) In additam. obf. 10.
('*) N. 12.
r9- When
Letter XXX. Article 19, 20. 59
19. When I read over that firft obfervation, which I j Lift now mention'd,
and thole things which are upon the fubject of throwing up polypous for-
mations by vomiting, and on the fubject of vomiting, in confequence of dif-
caies of the parts that conient with the ftomach ; ibme things were brought
back to my mind which, if I add them here, you will perhaps not read
with reluctance. Willis then, in this obfervation, affirms that " if a con-
** ftant fuftufion of bile happen, in the parts that are near to, or in contact
" with the ftomach," a frequent " vomiting is excited," becaufe the external
coat of this vifcus is, for that reafon, frequently, and greatly, irritated, and
that " he had obferv'd this in many who were difiected after death." And
I not only believe that this may have been feen by that very excellent man,
but even confefs, that there may be fometimes fuch an acrimony of the
bile, and fuch a power of irritating, and penetrating, as to make it the ac-
cidental caufe. of vomitings, especially in thoie perlbns, who are endow'd
with a very exquifite fenfe •, and if the tincture of the bile extends itfelf very
far, and reaches to the interior parts of the ftomach: which Platerus, as
you have it in the preceding feventh fection, of the Sepulchretum (V), has
particularly obferv'd in thofe " who, when living, were troubled with con-
" tinual heats of the ftomach."
Yet there is more than one reafon which has fbme influence in preventing
my aflent. For in the firft place, I doubt, whether the particles of the bile
that tinge the parts which lie round the gall-bladder, efcape from thence
while the perfon is living, or only after death, where the refiftance of the
coats is lefien'd, and the interftices which lie betwixt fibre and fibre, are re-
lax'd. And in the next place, I have fo frequently feen the neighbouring
parts of the gall-bladder have a yellow hue in dead bodies, as 1 have like-
wife faid in the preceding letter (<?), that it does not feem to be the caufe of
-any peculiar injuries to ibme perlbns, but the caufe of thofe which are com-
mon to moil perlbns while living. Finally, unlefs it be certain ; and it is by
no means certain •, that when thefe gentlemen have afcrib'd fuch a tincture
in that place, there was nothing elfe in the bodies, to which either the fenfe
of heat, or the vomitings, might be imputed j there is a very great propriety
in doubting, whether thefe effects are to be afcrib'd to that caufe. An in-
ftance of this kind, which confirms the propriety of doubting, I will give
you in a little whelp that I difiected, when I was a young man at Bologna.
For it is much to our prefent purpofe, and I fee that obfervations taken from
dogs, are not only produe'd in other parts of the Sepulchretum, and than
frequently, but particularly in this very fection (f).
20. A young whelp died fuddenly after great vomitings. The antrum
pylori, where it was contiguous to the gall-bladder, I found to be tin^'d
with a yellow colour, which had reach'd from the outer coats, quite to the
inner ; it ftop'd, however, at the internal coat, fo that the matter which was
contain'd in the ftomach, refembl'd even the white of an egg, in its colour.
While I was enquiring whether there was any thing elfe which deferv'd
remark, I faw that a part of the centrum tendineum of the diaphragm, was
likewife yellow, which being very thin, and particularly, in that tender age,
{d) Obf. 16. (*) N. 13. (f) Obf. 68.
I 2 had
60 Book III. Of Difeafes of the Belly.
had tranfmitted this yellownefs into the cavity of the thorax, in fuch a man-
ner that forne final] contiguous part of it was yellow, though but fiightly.
Ail the parts being now infpected, and found to be quite found, it came
into my mind to lay open the inteftines, by cutting into them longitudinally.
In their cavities was a great quantity of mucus, and in that mucus, near to
the more extreme part of the fmall interlines, were ten round worms, all
of them nearly of equal thicknefs, and of equal length alfo ; and this length
was about i'even inches.
21. Would you rather choofe then, to attribute thofe irritations, which,
by vellicating, and convulfing the fibres, had brought on fuch violent vo-
mitings, and, at length, fudden death, to this yellow tincture, although it
had not only infected the ftomach, but a tendon of that nature alfo, or to fo
great a number of worms of fuch a kind, whether they had crept into the
ftomach, or had continu'd where they were ? You will hefitate at leaft, and
will not affirm the firft pofition for a certainty.
But you would hefitate (till more, to go on to the fecond, if you mould
chance to believe, what is related in the additamenta, to this fection (g), of
the fervant-maid of Altemburg, who difcharg'd lizards, toads, and frogs,
and fometimes even thofe that were not dead neither, but fuch as liv'd, by
the fpecial licence of heaven, " to the fixth day," from the mouth, and
anus, and even, as fhe herfelf faid, from the genital parts ! It happens very
luckily, that the learned gentlemen who have firft written fuch abfurdities, do
not fay that they were prefent, when thefe living beafts were difcharg'd •, left
we mould be under a necefiity of concluding, contrary to our candid inclin-
ations, that their eyes were deceiv'd, and play'd tricks with, by a fet of jug-
gling women. For I fhould fuppofe that, in fact, there was nothing real in
the things of this kind, which the woman did difcharge, but a fort of ex-
ternal, and accidental, likenefs to thofe animals : and that the body, and
confidence, of them, had been made up of polypous concretions, ting'd with
the green colour of the bile.
It happen'd many years ago, that a virgin who was, herfelf, very virtuous,
and honeft, and born of honeft parents, began, at the latter end of lent, to
complain of a kind of troublefome fenfe of torture, and weight, with which
the ftomach was affected, and particularly at the time when digeftion was
going on. After this came on a pallid complexion, and an evident wafting
of body. At length, about the end of two months, from the beginning of
her complaints, fhe was feiz'd, a little before the middle of the day, with three
very violent {trainings to vomit, join'd with the greateft lofs of ftrength, and
a fainting-, in the firft of which (trainings, ihe brought up nothing at all, in
the fecond not a great quantity of a very bitter, and yeilowifh humour, and
in the third, at which time the phyfician, who gave me this account, by let-
ter, was prefent, fhe threw up a fubftance, which I fhall defcribe to you,
exactly in the fame manner, that it was defcrib'd to me, by this phyfician.
It was a fmall plant, or rather a little herb, about an inch long, furnifh'd
with radicles, a ftalk, and three leaves at top, one of which was denticulat-
ed, the others perfectly refembling a femicircle, and all of them being green.
(£) Obf. 5,
The
Letter XXX. Article 22. 61
The dalle, on its upper parr, was white, and, on its lower part, green, ex-
cept that it was diftinguifli'd with forne very fmall, and bloody (true. Af-
ter three or lour hours, the herb being now dry, had contracted itfelf, yet
ftill retain'd its colour. Being accurately examin'd by many perfons, and
among thefe by ionic, who were flcill'd in botany, before it was waited away
by frequent handling, and become altnoft friable-, there was not one, among
them all, who could fay of what genus it was. The virgin, however, after
the difcharge of this fubftance, felt not the leaft uneafinefs in her ftomach;
and indeed evidently recover'd her colour, and her flefli, when this accountwas
fent to me, by letter, which was not many days after. It was enquir'd of me
what I thought of lb ftrange, and unhear'd of, a kind of vomiting. There
was not any reaion for me to imagine the fame thing to have happen'd, in
this cafe, that happen'd in the obfervations of fome perfons, as for in fiance,
of Lentilius (b), who fays that he had feen " lettices thrown up by vomit-
" ing, with the flowers of the Indian crels, borrage, and rotes, little, or
" not at all, chang'd in their colour, which a woman of the firfl rank, had
" eaten fourteen day-, before."
For to take no notice of other things, this virgin could not endure to
eat herbs, fallads, or fucculent plants of any kind. One or the other, then,
of thefe things remain'd certain, that fhe had either thrown up an excrefcence
in the form of a herb, or a polypus, from her ftomach. And the preceding
difagreeable fymptoms, the vaft (trainings to vomit, the bloody ftriie, ob-
ferv'd on the body that was thrown up, and the whitenefs of its colour-, for
whatever there was of greenefs, that might have been brought on by the
bile being mix'd with acid juices ; all thefe things, I fay, feem'd to confirm
one or the other of thefe conjectures : but which it would be the beft to fol-
low, I thought would be beft determin'd by the enfuing circumftances of
the cafe, that is by there being new uneafinefies of the ftomach, or none at
all, or what not. And this is a fummary of the anfwer, which I immediate-
ly return'd to the phyfician, who coniulted me thereon : nor did I afterwards
hear any thing farther of this virgin.
22. "What I mail add, in the laft place, of vomitings that relate to the
difeafes of thofe parts, with which the ftomach confents, will perhaps be
more ufeful to you. For that which prevents me from putting off the con-
fideration of thefe vomitings, till we come to the diforders of thofe parts, as
I have done in regard to other vomitings, is that I have no difiection to give
you under this head. There was a collegue of mine, a very confiderable
man, the grandfon of a celebrated writer, and himfelf alfo worthy of great
praife : who, v>hen he was fixty years of age, began to be atack'd with fre-
quent and very troublefome vomitings, though they fometimes were quite at
reft for a day. What he threw up had nothing particular in it. He was
attended, out of regard to the dignity of the patient, by three phyficians,.
who were thought to be the moft fkilful, at that time, and without doubt were
fo, or at leaft they were the oldeft. As they did not doubt but the caufe of the
diforder was in the ftomach, they applied iuch things as they thought proper
to remove it, and thefe in great number, and variety, and for a long time to-
(/•) Vid. append, ad a. . i. dec. 3. eph, n, c. inparalL ad obf. 92.
gether ;-.
62 Book III. Of Difeafes of the Belly.
gether ; but every thing was in vain ; till at length the patient becoming more
emaciated, and tir'd out with the fiavery of taking medicines, determin'd,
with himfelf, to have done with them all, and retire into the country-,
whence having return'd again into the city, not long after, he was feiz'd in
the evening, with a great coldnefs over his whole body, without any manifeft
caufe, and on that very night difcharg'd a great quantity of blood, with
his urine. Soon after a great quantity of pus follow'd the blood, through
the fame paffages. Wherefore bloody, and purulent, urjnes fucceeding each
other alternately, his ftrength was foon pull'd down, and within a very few
days he clos'd the period of life.
From this event of the difeafe, it is natural, and eafy, to perceive, that
the caufe of the vomiting was not in the ftomach, but in thofe parts that
ferve for the fecretion of the urine, and particularly in the kidnies, inafmuch
as they are wont, fo eafily, to draw the ftomach into confent, and excite it
to vomitings. And, at the fame time, it is underftood, what was indicat-
ed, not by the flupors of the legs indeed, but by the pains, however, of
which the patient had been accuftom'd to complain very much even from
the very beginning of the difeafe ; what was indicated by the unufual ftimu-
lus to make water, fo that he could fcarcely retain his urine, till he got the
chamber-pot into his hand, and frequently, indeed, not at all, but efpecially
in the night ; and, finally, you will perceive what conclufion might have been
drawn, from a kind of hardnefs about the right epicolic region, as GlifTon
(z) call'd it, without doubt, thefe fymptoms taken all together, notwithstand-
ing the patient did not generally complain of his loins, might have given
fome hint to the phyficians, particularly in conjunction with the inutility of
every method of cure, which had been applied to the ftomach, that the
caufe of vomiting was inherent elfewhere, than in the ftomach ; and that in
the kidnies, and particularly in the right, that fome collection of morbific
matter was probably made.
To this fufpicion fome weight might have been added, from this enquiry,
that I would always have you remember to make, in cafes where the caufes
of a difeafe are obfeure, and uncertain, and obftinately refift a cure, I mean
to what diforder the anceftors of the patient had been liable. For by this
interrogation, it would have been difcover'd, in the prefent cafe, that dif-
orders of the kidnies had been very common in this illuftrious family. And
thofe things which naturally occur'd to my mind, upon hearing the cafe of
my collegue, and from knowing the preceding fymptoms, you will fuppofe
are wr-itten, not to accufe any one, efpecially the dead, which is not the leaft
part of my intention, but only to aflift your ftudies. Farewell.
•(/) Traft. de partib. continent, c. 2. n. 10.
LETTER
Letter XXXI. Article i. 6%
LETTER the THIRTY-FIRST,
Treats of Fluxes of the Belly, with or without Blood.
i.fTM-IOSEfubjetfls that, in theSepulchretum anatomicum, are diftribnt-
X ed into four lections, " the cholera morbus, fluxes of the belly without
" blood, dyfentery, and preternatural excretions of the belly," all thefe, I
fay, I choofe rather, fhould be comprehended in this one letter. And the
realbns of this refokition are thefe. In the firft place, the cholera " may
" feem to be a diforder common to the ftomach, and inteftines," as Celfu's
rightly fays (a) •, for there is a difcharge by ftool, and a vomiting at the fame
" time." And as I have treated of the diforders of the ftomach, and am
about to treat of the diforders of the inteftines, it is impofiible but I muft
have already lit upon this diforder, which is common to both, or muft light
on it hereafter ; fo that there is not the leaft occafion to treat feparately of it
here, and flightly in particular ; for Bonetus himfelf, who wrote the ninth
fcclion upon this fubject, fcarcely fill'd up three pages, and the greater part
of them is taken up by the fcholia, that are plac'd between.
You know, befides, that it is my determination to repeat nothing. But
he taking quite a different method, was fo far from hefitating, whether to
make ufe of the fame obfervations, here alio, which he has made ufe of elfe-
where, that even in this very fhort fection, he has given one of them, and
has not only interfpers'd the twelfth feclion, with a great number, as well
as the two remaining fections, but has even almoft wholly made it up of
them.
To this you may add, that parts of the fcholia are not only repeated in
different fections, as that which is given in the tenth (£), from de Graaf, is
repeated in the twelfth (f), but even in one, and the fame fedlion ; as for
inftance, when, in the tenth fection, what is taken from Willis, and what is
taken from Ballon ius, and fubjoin'd to the feventh obfervation, are both
equally repeated, the former in the appendix that follows the twenty-eighth
obfervation (i), and the latter immediately below this very obfervation. Be-
fides, not to quit the tenth feftion, there are fo many things added upon
the transfufion of blood, & chirurgia infuforia, as it is call'd, under the fixth
obfervation, that they exceed the whole ninth fe&ion.
(«) De medic. 1. a. c. II. (r) Ad obf. ie.
(b) Ad obf. 25 . (d) §. 2..
Finally,
64 Book III. Of Difeafes of the Belly.
Finally, thofc bloody flools which are the immediate confequences of a
wound, inflicted on the flomach, or the liver, certainly do not belong to
the clafs of dyfenteries, which is the title prefix'd to the eleventh feclion.
Yet I fee that two obfervations, of this kind, are produe'd, here, under num-
ber twenty-five. As I do not permit myfelf, therefore, to take pattern
from any of thefe improprieties, there cannot be fo great a quantity of mat-
ter, but it may be very well comprehended in a fingle letter. Dividing
fluxes of the belly then, into thofe that are without blood, and thofe that are
bloody, I will immediately produce two obfervations upon the firfl fubject,
from the papers of Valfalva.
2. A young man, who, through the whole courfe of his life, even when
he was in the highefl health, had frequent occafions of going to flool, having
reach'd his twentieth year, was feiz'd with griping torcures of the bowels,
attended with frequent bloody flools, that is with a dyfentery. After twelve,
or fifteen days, this was chang'd into a fimple diarrhoea, with flools of a
yellow colour, but without gripings : and this feeming to be fomewhat mi-
tigated, by the help of remedies •, a fimple tertian fever came on, which was
put a flop to within a month. The diarrhoea ftill continuing, he was at-
tacked of a fudden, with an acute fever, which had manifeft acceffions.
His pulfe was frequent, quick, foft, fmall and weak. To thefe fymptoms
was added a flupor of the fenfes, a confiderable deafnefs, and a peculiar
kind of fwelling of the anterior part of the thorax, on the left fide. In this
manner, he died about the fourteenth day, from the beginning of the acute
diforder, at which time of the difeafe, what kind of flools the patient had,
the attendants did not obferve.
The belly, although it feem'd to be not at all fwelPd, contain'd, neverthe-
lefs, a great quantity of fanious ichor, which ifiu'd out of the inteftines, in
many places, where they were perforated to fome confiderable extent. This
tract comprehended the extremity of the ileum, and the nearefl part of the
colon befides, to the extent of two hands breadth. In that part the intef-
tines were eroded, and ulcerated, and on their internal furface even affected
with a gangrene, fo that you fee they might be eafily perforated. Near to
this tract fome of the glands of the mefentery had grown out into a tumour,
wherein Was .ichor, not unlike that which had burft forth into the cavity of
the abdomen •, but the very fubflance of this tumour was foft, and flaccid,
and feem'd to incline to corruption. The fpleen was three times as large as
it naturally is.
The fkin, and mufcles, of the thorax, where the fwelling was, difcharg'd
a great quantity of ferum, when they were cut into, efpecially at the upper
fide of the flernum : for from thence, that is from the -borders of the pec-
toral, and fubclavian mufcles, ferum gufh'd out, as if from feveral little ri-
vulets. The lungs, however, were found. Within the pericardium was a fe-
rum, like water in which frefh meat has been wafh'd. If you touch'd the
heart, you found it to be fo lax, and foft, that it feem'd to be not mufcular,
but membraneous. In the ventricles thereof was a fluid blood, and this
was fo frothy that it refembl'd the lixivium made ufe of by -barbers, when
agitated. And all the veins contain'd fo great a quantity of air, that al-
though they contain'd but little blood, they were neverthekfs extremely
5 turgid,
Letter XXXL Article 3, 4. 65
turgid, and in particular one branch of them that belongs to the fpleen ; for
this branch, though it did not feem poillble that it fhould be more dilated,
had fcarcely any remains of blood in it. Within the cranium was found a
little (brum: but the brain itfelf no where fhew'd any marks of injury.
3. The great force of putrefaction (to begin from the latter part of the
hiitory, and to return to the former part immediately after) in this body,
appear'd from the great quantity of air that had been difcharg'd, the great
laxity of the heart agreed very well with .thofe fmall, and weak pullations.
I have frequently oblerv'd the fpleen to be enlarg'd, after other fevers, efpe-
cially when they had appear'd in different forms.
But to omit other things, and come to thole, on account of which, in par-
ticular, I related this obiervation to you, at prefent-, you fee, in the firft
place, how much it, at length, colt this young man, to have his belly per-
petually lax, that is, not moderately moilt ; for we are not ignorant of the
aphorifm of Hippocrates (e) ; but more moiit and lax than it naturally is, and
from an improper mode of living eafily made (till more fo. On the lax inte-
Itines, therefore, an attack was made by vitiated and redundant humours, lb
that they were not able to bear up under it. They were fir ft troubled with
a dyfentery. This left, according to the appearance of the cafe, the begin-
nings of ulcerations, which were the lets attended to, becaufe the inteltines
being then already more relax'd, were not fo extremely fenfible to pain, as
they would otherwife have been, and becaufe the fanious ichor was hidden by
the yellow flux, which had fucceeded to the dyfentery.
The flux had fucceeded, in confequence of a part of the deprav'd matter,
being carry'd back, from the inteftines into the blood, after having been vi-
tiated, in the inteltines, ftill more. And this being brought back again
into the inteftines, together with the bile, and the other juices, whole recep-
tacles, and containing parts, were irritated by the mixture of this humour,
the flux was not only kept up, but the erofions were alfo encreas'd ; fo that,
at laft, where thefe erofions were made, the inteftines were not only feiz'd
with a gangrene, but corroded, quite through their fubftance, by the moil
ill-condition'd ichor. And that this deprav'd matter was carry'd back in-
to the blood, as I faid jult now, is not fo much prov'd by the fevers that
follow'd it, as by the tumour of the myfentery, which lay as near as poflible
to the ulcerated tract of the inteftines. For thefe ill-condition'd ichors being
continually taken up, from that tract, and carry'd to the neighbouring glands,
by the chyliferous ducts, at length deprav'd their internal ftructure, lb that
the paflage of thefe humours being now obftructed, they evidently ftag-
nated in thofe glands, and rais'd them up into a tumour.
4. And from hence another caufe was added, which encreas'd the flux, I
mean the deprav'd ichcr ftagnating in the inteftinal canal, which, before,
had been carry'd off, by the paftages that were now obftructed. This kind
ot obftruction, when it takes place in molt of thefe paflages, not only en-
ereafes fluxes of the belly, but is even the caufe of them, and, in particular,
of that which they call the caeliac flux : with which take care not to con-
found the caliacus morbus that is defcrib'd by Ce\ius(f). For in this " there
(*) 53. f. 2. //; L. 4. c. 12.
Vol. II. K
i&
66 Book III. Of Difeafes of the Belly.
u is no motion to (tool," but in that, of which I fpeak, even the chyle it-
felf is difcharg'd, mix'd, beyond doubt, with recrementitious matter, fo
that the ftools are render'd almoft of a cineritious colour, and not white, as
they imagine, who do not attend to this circumftance, that the chyle is not
to be found feparate from the other ufelefs parts of the aliments, except
within its own proper vefTels. Nor have they, who aflert that they had ken.
white ftools, meant any thing more than ftools of a whitifli colour, I mean
if they are compar'd with the natural excrements, or if they did really mean
white, the whitenefs was that of a purulent matter, or of a mucus fimilar to
pus, or fomething elfe of that kind •, as, for inftance, if any one„ troubled more
with a lienteric, than a cseliac diforder, mould difcharge by ftool the milk
that he had taken in, unchang'd.
For in the lienteric flux, the aliments are not concocted, and prepar'd, as
in the celiac, whether the juices, by which they ought to be prepar'd, are
unfit for performing that office, or the ftomach, by too precipitate a motion,
throw them out almoft as foon as they are taken in, or whether the ftomach
itfelf being lax, and there being a total refolution, or, at leaft, but little
conftriction of the pylorus, fuffers the aliments to flip out without digeftion;
although there was nothing lienteric in that old man, the orifice of whole
pylorus I have defcrib'd to you, on a former occafion (g), notwithstanding
it was not only, of itfelf, much larger than it ufually is, but what is ftill
more remarkable, furnifh'd with no protuberating ring, in the greater part
of its circumference. Nor was there even any thing of a caeliac affection -y
neverthelefs there are many learned men, who fuppofe that the pylorus is
" too much dilated," in this diforder. I, however, do not fuppofe any pe-
culiar caufe to be latent in the ftomach ; but, fometimes, rather in the tube
of the inteftines, whether, by an accelerated motion, the ingefta are prema-
turely difturb'd, and carry'd off, before the chyle can be properly extracted
irom them, or by reafon of the motion being languid and flow, that which
has been extracted, is impell'd no farther ; fo that ftagnating in the fmall
roots, as it were, of its proper vefTels, a farther abforption of chyle is pre-
vented, juft as it is prevented from going on, by an obftruction of the me-
fenteric glands, as 1 hinted a little above : not to add any thing upon the
iubject of cicatriz'd ulcerations clofing up the mouths of the lacteal vefTels ;
of which circumftance you will find examples in the Sepulchretum (&), as
you will likewife of the obftruction of thofe glands, in bodies that, when
living, had labour'd under the paffio cseliaca.
Obfervations of the lienteric flux, or of one that was nearly of the fame
nature, you will have to add to the others, from the volumes of the Gdarean
academy (z), not indeed without obstructions, of thefe, and of other glands,,
but, at the fame time, with the coats of the ftomach being depriv'd of all their
Strength, and at other times with the parietes of the ftomach, and of almoft
all the inteftines, being reduc'd to the thinners of paper.
But let us return from this digreffion, into which I fell accidentally, and
which neverthelefs it may not have been altogether ufelefs to have touch'd
upon here, to the obfervations of Valialva.
(g) Epift. 21. n. 15. (;) Aft. n. c. torn. 2. obf. 65. & cant. 6,
(-) Sect. hac. 10. Obf. 2, & 4. ac 5. obf. 94.
5. Aft
Letter XXXI. Article 5, 6. 67
5. An infant, feventeen months old, was feiz'd with a diarrhoea. To this a
fever was added, with a cough, and a kind of itching of the gums, and the
noftrils, which the child fignify'd by a frequent friction, with his ringers, up-
on thole parts. In the mean while the diarrhoea increas'd, and although the
ftools had, before, been yellow, or green, they now firft began to be ting'd.
with a bloody hue, and, at length, to be chang'd into a black colour, and
be attended with a fingultus, which was about the feventh day. On the
beginning of the ninth day, either fpontaneoufly, or by the force of an aftrin-
gent kind of remedy being apply'd to the feet, by the advice of an old wo-
man, they were entirely put a flop to. However, feven or eight hours had
fcarcely pals'd, after this obftructton, but being opprefs'd with ftreightnefies
of the prascordia, and agitated with continual anxiety, and tolling of the
whole body, he died on the fame day.
The inteftines being turgid with air, contain'd a fmall quantity of very
black matter, fuch as had been before difcharg'd. In the mefentery were
many facculi adipofi, and notwithstanding more than twenty-four hours had
now pafs'd, fince the time of the child's death, they, neverthelefs, contain'd
very fmall particles of fat, which were agitated by a tumultuary motion, one
with another. The lungs, on the back part, were fomewhat black, and par-
ticularly the right : they were found neverthelefs. In the pericardium was a
little water : but in the heart was not the leaft appearance of any polypous
concretion. In the brain was found a little ferum.
6. A diarrhoea, join'd with a cough, and an itching of the noftrils, might
have given a fufpicion of worms in this little boy : none of which however
were found. But the itching of the gums really fhew'd that teeth were about
to cut through them. For fo he who faw the cafe judg'd, that is Valfalva,
when he mark'd out this obfervation, in his little index, in the following
manner. " A diarrhoea with difficult dentition, and convulfive motions."
And how eafily dentition may excite convulfions, you yourfelf are not igno-
rant, and I have, on a former occafion, confirm'd (£), by giving you two
fatal cafes of infants, at the fame time pointing out where I fliall demon-
fixate, by what means it alfo brings on a flux of the inteftines, and by what
means this, if it be moderate, prevents convulfions coming on. And from
hence you perceive, how very dangerous it muft be, for an inteftinal flux to
be Suddenly and totally ftop'd, at this time, in particular, as a fudden and
total ftoppage thereof, at other times, is never without confiderable danger.
But if the matter that has been difcharg'd by ftool is, moreover, of the molt
pernicious properties, this matter being confin'd within the body, may not
only bring on death, but a very fpeedy, and a very violent one. And that
the matter, in this cafe, was of a malignant and destructive nature, is not
only fhown by the colour of the ftools, and the fingultus, but by that very
ftrange, and unufual, motion in the particles of the fat, whatever it was (for
fo ftrange it is, that I mould credit few befides Valfalva, in this matter) is
more than fufficiently demonstrated.
But to fpeak only of the colour ; do not imagine, becaufe that very black
colour, of the difcharg'd matter, fucceeded to the bloody tincture, that the
(*) Epift. 9. n. 4. &Epift. 10. n. g.
K 2 ftools
63 Book III. Of Difeafes of the Belly.
(tools were nothing but blood. For Valfalva was not a man of this kind,
that he could not eafily tiiftinguifh blood, when difcharg'd, or remaining be-
hind, in the inteftines, after death, if it had really been blood. Wherefore,
either that tincture, which was fuppos'd, by the women, to be owing to
blood, was fome portion of very ill-condition'd humour, then firit beginning
to burft forth, and to tinge the matter, that was before contain'd in the in-
teftines, or if it was really bloody, it diftiil'd from fome fmali vefiels, which
the more acrid part of this deprav'd humour had eroded. And this recent
humour being encreas'd, by the addition of other juices, either in the gall-
bladder, or in the cavity of the inteftines, the nature of which you may, in
fome meafure, guefs at, by the experiment of de Graaf, which is alfo copied
in the Sepulchretum (7), gave that very black colour to the whole mixture,
and reprefented the atra bills of the ancients, by its pernicious effects. How
violent, and how fpeedy, a death it alio brought on, in that fmith, of whom
I wrote in the laft letter (;;?), you certainly remember. Neverthelefs it
fometimes happens, though but feldom, and with difficulty, that a perfon irr
ihefe circumftances is fav'd. And as I happen'd to meet with this, in an-
other fmith, in the year 1710; I will not make any fcruple to give you the
heads of that obfervation, in this place.
7. A young man of a (lender habit, but ftrong, both in regard to confti-
tution, and years, nor lefs aduft by means of his art, than by his tempera-
ture, being fubject to haemorrhages of the noftrils, and having been long
without them, was feiz'd, in the beginning of the fpring, with a fever of a
malignant kind. Some perfons of the firft rank, in the place of my nativity,
•who were fond of this man, as a very ingenious artift, beg'd of me, that I
would enter into confultation with his phyfician, who, though an elderly
man, had no objection to this ftep. The reafon of this defire was, that the
cafe was redue'd to a great extremity. For to the other fymptoms had been
added, on that day, fo great a difcharge of blood from the noftrils, that, as
within five hours, it had been difcharg'd to the quantity of ieven pounds, nor
could as yet be ftop'd, by any means whatever j the man's ftrength and pulfe
were almoft ready to fail.
We both of us, in conjunction, did all in our power to reftrain this hae-
morrhage, and to obviate the other fymptoms. But fcarcely had the blood
begun to be ftop'd, when what we were afraid of came on, that is the fever,
being exacerbated, according to cuftom, about noon, renew'd the haemor-
rhage. Being again bufy'd in giving afliftance to the patient, behold black
ftools began to be difcharg'd. And although it was natural to fuppofe, that
thefe were part of the blood, that had flow'd down by the pofterior foramina
of the noftrils, into the fauces, and ftomach, the patient affur'd us that he
did not perceive any thing to trickle down, from the fauces, into the gula : and
this was confirm'd by the appearance of what had, in the mean while, been
brought up by vomiting, in which there was nothing bloody or black. And
having after mat inipected all the cloths, upon which the difcharges from the
inteftines were receiv'd, and feeing a black colour indeed, but nothing
(/) Ad. obf. 15. fea. 12. (m) N. 16.
5 bloody
Letter XXXF. Article 7. 69
bloody amon^fl them •, it not only brought to my mind the well-known pre-
dictions of Hippocrates, but alio the cale of that young man, mention'd by
Ballonius (»), who being afFectA! in a manner very fimilar tothatof our patient,
andhavii larg'd black ftools, after too great a hemorrhage from the
noilrils, died on the feventh day or' his fever.
And there was here lb much the greater reafon to fear, becaufe, as Bal-
lonius neverthekfs, fufpe&ed that the blood had flow'd down, from the fau-
ces, into the ftomacb, we were, as I laid before, but little at liberty to fuf-
pedf. the fame, and indeed left and lefs lb, the more we confider'd all
thin
for as the ancient phyficians, in the opinion of whom is Sennertus(c),.
divide black ftools into thole which are bloody, and thole that are owing to
;i natural melancholic humour, and, finally, into thofe which are from atra
bilis, and teach us, that the twofirft kinds are attended with lefs danger, but
that the lad kind is extremely dangerous, that is to fay, thole that " are
" black, fhining and acrid j" thele which we law were, certainly, very black,,
and fhining, and, as the patient complain'd, acrid alfo. On the following
night he had the fame kind of ftools, except that they were fomewhat
lels fluid. Yet after that he had no more of the fame kind : but the milk
which was thrown up, by way of glyftcr, he difcharg'd at firfc tinctur'd with
the colour of tobacco, and on the following days of a brOwn colour, mix'd
with a flight yellow : yet whatever was difcharg'd, had the mod offenfive
fmell. Notwithstanding this deplorable ftate of things, however, the pa-
tient, by the blefllng of God, efcap'd, and his former health was entirely re-
ftor'd ; but he was not free from his black ftools before the twenty-fourth
day, and they had begun about the fixth day of the fever •, nor was he, af-
ter that, without many various, and grievous fymptoms, which for a long time
afflicted him.
Amongft thefe, were pains of the belly, third, a roughnefs, and blacknefs
of the tongue, and though he drank often, a drynefs ; and while he drank,
there was a found, as if he threw what he drank down into a deep place, his
voice was hoarfe, and low, he had a trembling of his hands, a fubfultus of
the tendons in his wrifts, an inconftancy of the pulfe, and often a fmallnefs,
and, if you prefs'd upon it, a great weaknefs, and fometimes a very con-
fiderable, and almoft inexplicable, inequality, but always a frequency, and
efpecially when the fever was very hot, and violent, which was very often the
cafe ; the refpiration was various, i'o that it was fometimes deep, and even,
fometimes, not without difficulty ; his deep was, at firft, laborious, and af-
ter that there was an exceffive, and almoft continual, drowflnefs, he even flept
with his eyelids brought near together, and yet with his eyes not quite fhur,
he was fometimes not quite free from delirium, had a flownefs in anfwering,
a difficulty in forming his words, and a forgetfulnefs of giving notice, when
he had occafion to go to ftool, or to make water, befides being heavy of
hearing, and lying on his back, as if the power of turning himfelf, on his
fide, was, at that time, taken away, whereas, at other times, there was, for
(») L. I. Confil. 98. (0) Med. pra&. I. 3. p. 2. f. 2. c. 10.
the
jo Book III. Of Difeafes of the Belly.
the mod part, a greater power of exertion in the mufcles, and a greater rea-
dinefs to take nourifhment, than that heavinefs, and the other fymptoms,
I have mention'd, feem'd capable of permitting.
As many of thefe fmyptoms, and the worft of them, in particular, fhow'd
themfelves more than once, and for a long "time together, they caus'd us to
be, for a long time, more in fear, than in hope, as toj the event of the dif-
eafe, while every other perfon whatever, who faw the patient, pronounc'd
him quite defperate. But nothing feem'd to us, to be of lb much advantage,
as the great quantity of urine, that was difcharg'd •, for the fweats were but
little, and not frequent, nor did they ever appear over the whole body, and
what the interlines difcharg'd, was generally but fmall in quantity, and not of
fuch a nature as to be likely to give relief, notwithstanding a worm was, fome-
times, obferv'd in the flools.
8. But black flools, of that kind, are pernicious, not fo much on account
of their quantity frequently, as in their effects, and are always the proofs of
a very ill-condition'd humour, which gives rife to them.
Yet other inteftinal difcharges, that are equally free from blood, as the
yellow, the green, the watry, and others of this kind, are, fometimes, not
deftruclive by the pain they create only, but by their quantity alfo. And all
thefe excretions generally owe their origin to fome flimulus, that irritates
the interlines, by what means, or from what part, foever, it got down into
them : for as we fee that a great quantity of humours is difcharg'd, by means
of medicines violently purgative, fo we may fuppofe that from fome flimu-
lating fluid, which is generated within this canal, or lent down thither, from
the arteries, the fame thing rnufl of courfe happen.
For befides the pancreas, the liver, and the gall-bladder, there are, by
reafon of the very large extent of furface, in the interlines, innumerable paf-
fages, though very fmall indeed, through which any thing unufual may be
feparated from the blood. And thefe fame innumerable pafTages, when the
interlines are frequently, and for a long time together, llimulated, convey
an incredible quantity of ferum. Nor are we to fuppofe, with the common
people, that whatever is difcharg'd of a yellow, or green colour, is all of it
bile, efpecially fmce from the experiment of Diemerbroeck, which you have
alfo in the Sepulchretum (p), it is eafily perceiv'd, with how fmall a quantity
of bile, a great quantity of water may be ting'd. Nor is there any necefiity
for afcribing the griping pains, with which the patient is then affected, to the
quantity of bile, which is mix'd with the flools, fince Willis has defcrib'd
diarrhceas " almoft watry, and limpid (q)" which he neverthelefs chofe, on
account of the " griping tortures," that attended them, to call dyfenteries.
And thofe which attack'd many of the inhabitants of London, who were, the
day before, flrong, and in good health, particularly in the autumn of the year
1670, reduc'd their flrength to fo great a degree, within thefpace of twelve
hours, that they feem'd juft'ready to die, and that not from the great quan-
tity which had been difcharg'd ; for he fays, " that if an equal quantity of
(p) In. fin. fchol. adobf. 3. §. 1. fe&. 9. (q) Pharmac. Ration, f. 3. c. 3.
" pure
5
Letter XXXI. Article 9. 71
M pure blood had been difcharg'd, it could not have produc'd equal
M weaknefs."
But on the contrary, even the vaft quantity of ferum alone, that was dif-
charg'd, not only brought on an immediate fwooning, in the woman of
whom Marcellus Donatus gives the hiftory (r), but alio brought down al-
moft to the brink of death, the notary of whom Poterius fpeaks (j); for nei-
ther of thefe authors mention any thing of pains ; but the former fays, " that
" by one excretion, fo great a quantity of clear water was difcharg'd, as to
M fill a vefiel of a very large fize, that was made ufeof to receive it," and the
latter, " that through the whole of one day, more than forty pints of ferous
" matter was difcharg'd." Yet I would not deny, that there might be fome
irritating matter in chefe difcharges, join'd with a redundancy of ferum in the
blood, and perhaps with iomc laxity of the inteftines. I only fay this, that
it does not leem as if the pains had been fo fevere, as to make them deferve
notice, and that after fo j_reat a quantity of ferum having been excreted, no-
thing elfe was wanting to explain what happen'd to both of them.
For the blood vefiels cannot contract themfelves fo foon, as to embrace,
clofely, the column of blood that is greatly diminifh'd, though this is ex-
tremely neceflary, in order to put the blood into a proper motion, efpeci--
ally when it is in great meafure depriv'd of its fluidity, and, of confequence,
gives more refiftance to the force of the vefiels upon it, not to fay any thing
of the necefiity there is of the fame fluid humour, in order that thofe fe-
cretions, from the blood, may be fpeedily, and properly made, without
which life cannot fubfift, nor will I enquire, whether for thefe reafons, where
the queftion is of a very great, and fudden, efFufion from the vefiels, it is of
worfe confequences for ferum only, or for blood, itfelf, to have been dif-
charg'd, at the fame time •, for notwitwftanding ferum may be more fpeedily
and eafily repair'd, yet the blood which does not remain in the vefiels, with-
out its necefiary portion of ferum, is neither unfit for the fecretions, nor.
gives more refiftance than before, to the caufes which put it into motion.
9. And I could wifii it had happen'd to me, rather to bandy about this,
queftion in difputation, than to experience any thing of the kind myfelf, in
any fhape. But in the year 1733, when in confequence of a letter from his>
eminence the cardinal Annibal Albano, to which it became me to be obfe-
quious, I travel'd to and from Forli to Pefaro, and from Pefaro to Fprli, oni
poft-horfes, for the fake of confulting with a certain phyfician, I was attackM
with fo great a flux of the inteftines, that within twelve hours, I difcharg'd,,
at leaft, fixteen pints of almoft limpid water. The pains were flight: the
ftools not very frequent, but very large : and I know not how long they might
have continu'd, if a flight naufea had not put me in mind to try the efTe&s
of vomiting, by drinking a little quantity of warm broth. And although,,
naturally, I am by no means inclin'd to vomit, yet it fucceeded fo happily,
that having thrown up a greenifh little body, which feem'd to be a fmall leaf
of a boil'd herb, the naufea, and the inteftinal flux, were cur'd at the fame
time. But whether it was a real leaf, and if it was, where, or when, I had
eaten it, I could not find out, unlefs this might have happen'd on my jour-
(r) De med. hift. mir. 1. 4. c. 20. J (s) Obferv. cent. 2. C. 6z.
72 Book III. Of Difeafes of the Belly.
ney, while I was taking fome refrefhment, in an inn, haftily, and juft while
the horfes were chang'd •, for in this manner I might have fwallow'd it down,
whatever it was, unnotic'd.
How much danger I had then been in, I better underftood, when, on the
day following, I perceiv'd that my body, and particularly my face, and
hands, were grown thin, and lank, as If it had been from a very long, and
acute difeafe, and felt fo great a drynefs in the mouth, and fauces, that
although I wafh'd them over and over again, I found no advantage from
thence, and I faw that the water, which I had us'd for that purpofe, when
I threw it out of my mouth into a bafon, was made almoft black in the
mouth. And thefe fymptoms, together with a laflkude, laded two or three
days, and were, by degrees, diminilh'd. But the lofs of appetite for food
of all kinds, and what you will be more furpriz'd at, in fuch a drynefs, even
a lofs of appetite for drink, lafted fomewhat longer, till a broil'd fifh, and
a particular kind of wine, which, in its own nature, is bittcrifh, began to
be defir'd by the ftomach, and be well born by it. All which circumstances
I was willing to recollect minutely, and write to you, as they were not re-
ceiv'd from any other hand, or obferv'd in any other perfon, but taken by my-
felf, and from myfelf ; and thefe fuch as are not eafily to be met with, among
thole who have written upon diarrhoeas, not even Carolus Pifo excepted, who
is faid (/) " to have given a perfect defcription of this diarrhoea," that is of
the watery diarrhoea. For if you read over the whole chapter, which is at the
fame time quoted, and is entitled De Diarrhcea ferofa (a), you will not find a
cafe to compare with mine.
10. And if you enquire Into the caufes of this diforder, you fee that the pri-
mary caufe had been in the ftomach : and I think you cannot doubt, but
motion, and irritation, from which an excretion of ferum is brought on,
may be propagated to the inteftines, from a ftimulus affecting the ftomach.
Turn, in particular, to the obfervations of Jo. Riolanus, I mean the elder,
which you alfo have herein theSepulchretum (x): you will fee that a matron
died, within about fourteen hours, of inteftinal difcharges, " fimilar to white
" water, milky indeed, but liquid, and in fuch a quantity, as to fill a large
*' bafon, every time fhe went to ftool," and that the caufe of this was found
to be " an ulceration in the fundus of the ftomach."
But whence came fo great a quantity of water ? In regard to my own cafe,
I will firft fay, that in the preceding fummer, I had made ufe of it, to tem-
per thofe generous wines, with which only, my native place, at that time,
abounds, and had drunk water, in greater quantity than ufual, fome part of
which, notwithftanding when I was feiz'd with that flux, I feem'd to myfelf,
and to others, to be in very good health, might perhaps have remain'd mix'd
with my humours in rather a greater quantity than was neceffary. And on
the three days, which had preceded the two days, whereon I travel'd, and
on the very day in which I was feiz'd with that flux, there had been very
great, and almoft continual mowers of rain, fo that I might have drunk in a
(/) Vid. commerc. litter, a. 1734. 'hebd. 42. («) Obferv. de praetervif, ha&en. morbis ab
.ooit. num. iii. aqua ortis fed. 4. c. 1.
j*) Sed. io. obf. 18.
great
Letter XXXI. Article n. 73
great quantity of water, from the moift air, by the abforbing furface of the
lungs, and the whole body in general.
In the laft place, this happen'd to me in the beginning of October ; for
you have leen, that the watery fluxes defcrib'd by Willis (y), and you may
fee that the flux, which I refer'd to, as defcrib'd by Poterius (z), happen'd
in tiie autumn, and near to the fame time of the year, that, likewiie, which is
fpoken of by Marcellus' Donatus (a), as did alio the three firft, which are
taken notice of by Pifo (b). For when the air begins to grow cool, at the de-
cline of the Seafon, this watery humour, which flow'd copioufly from the
body, during the time of the fummer heats, and not by means of iweat only,
but by means of infenfible perfpiration alfo, is now retain'd, and added to
that, with which, for certain caufes, the bodies of certain men do, at that
time, more abound; fo that it is not to be wonder'd at, if where an irritation
of the inteftines comes on, as it did come on in me, with a great agitation,
and concufiion, of the body, and humours befides, from travelling very fafl;
to and fro on horfeback, and that for a long way too, it is not, I lay, to be
wonder'd at, if that does fometimes happen, which happen'd to me then.
11. But if you are not content with the many caufes which I have hinted
at, and think that fome other ought ftill to be enquir'd into ; that will be bet-
ter, than if you were to acquiefce in one of them, I mean the autumnal feafon.
For the fame time, the fame year, the fame city, that is the city of London,
had inteftinal fluxes fpreading through it epidemically, without blood in-
deed, but attended with griping tortures ; yet fo different were thefe difor-
ders, that if you compare the defcriptions of Willis (<r), and Sydenham (d)9
one with another-, you will be very much furpriz'd to find, that although
both of them give you an account of the fluxes, with which the inhabitants
of London were troubled, in the autumn of the year 1670, the one defcribes
" watery fluxes," and the other " mucous fluxes," nor does the former take
notice of fo much as one that was mucous, nor the latter of one that was
watery.
How could this happen ? For my part I mould fuppofe, that in a city of
this kind, which is, perhaps, more than any other, large and populous, it
had happen'd to each of them, according to their defcriptions, fo that the
one met with none but watery fluxes, and the other none but mucous.
And this difference I fhould fuppofe arofe from hence, that as in various parts
of a great city, there may be a various conftitution, and mixture, of air, va-
rious arts, and occupations of men, and other circumftances of the like kind,
fome bodies may abound with a more fluid, and others with a more len-
tefcent, and mucous, ferum ; fo that, although there might be the fame kind
of irritation in the inteftines of all •, the fluid, neverthelefs, which is prefs'd
out from the internal furface of their tube, will not be the fame in all.
But if mucus, or ferum, are now and then difcharg'd, ting'd with any other
colour, whether this is added by the bile, or they appear in this manner of
themlelves, there are, and have long been, many phyficians, who, following
the example of thofe Englifh gentlemen, provided there be frequent dii-
(j) Supra n. 8. (£) C. 1. ibid. cit. n. 9.
(z) (<r) Vid. c. cit. fupra ad n. 8.
(*) Ibid. («-') Obf. med. circa morb.acut. feft. 4. c. 5.
Vol. If. . L charges,
74 Book III. Of the .Difeafes of the Belly.
charges, not unattended with gripings, and pain, do not hefitate to call fluxe9
of this kind, though they are not bloody, dyfenteries. So I remember,
when I formerly liv'd at Bologna, that epidemic fluxes of this kind, which
ipread about at Modena, were call'd by the phyficians of Modena, in letters
that they fent to the phyficians of Bologna, dyfenteries, which appellation the
latter did not difapprove. Letters of this kind, in particular, I read, that
were lent to Albertini, by one of whom I have already fpoken to you f>), I
mean Jo. Francifco Bernardoni, and in thefe letters, I read amongft others,
a hiftory, which I think ought not to be pafs'd over here, as it has the de-
fection join'd to it. For as, by reafon of the fame griping tortures having at-
tended thefe fluxes, which attend dyfenteries, a fufpicion had arifen of blood
being difcharg'd, but conceal'd under other colours ; Bernardoni was willing
cither to remove, or confirm, this fufpicion, by diffection. And this was the
manner, in which he related the cafe, in thofe letters, which he afterwards
confirm'd in my prefence, with his own mouth.
12. A prieft, who labour'd under an inteftinal flux, difcharg'd various
kinds of humours, and thefe difcharges were attended with very fevere pains
of the bowels, but in them there appear'd neither any thing bloody, nor
purulent. He died on the thirteenth day of the difeafe.
All the inteftines being examin'd, clofely, on their internal furface, and
that more than once, fhew'd no where any erofion, much lefs any ulceration.
And what feem'd more furprizing ftill, they were not without that mucus, as
it is call'd, with which they are naturally fmear'd over.
13. But is it fo likewife in bloody dyfenteries ? For I mail call them bloody
here, to diftinguifh them from thofe that were without blood, which I fpoke
of laft ; though, at other times, and indeed prefently, I mail call thofe that
are bloody, dyfenteries, without the addition of any epithet whatever, accord-
ing to the cuftom of the Greek phyficians ; the ancient Latin phyficians us'd
to name them tormina. Both of which appellations you may, in particular,
learn, from Celfus (f).
Celfus does not doubt, but that in a dyfentery, ** the inteftines are ulce-
*' rated, internally," and that blood " is difcharg'd from them, fometimes,
" with a kind of mucous matter, and that, at other times, fome kind of
" flefhy portions, as it were, are difcharg'd, together with the blood," fol-
lowing the opinion of the more ancient phyficians, and amongft thefe, of
Hippocrates (g), who had, neverthelefs, call'd thefe flefhy portions, " a kind
" of caruncles." And indeed the inteftines are often ulcerated : but not al-
ways. Both of which pofitions are to be demonftrated.
For, in the firft place, there are fome who affert, that this fcarcely ever
happens, and perfons of this kind have even come to the knowledge of the
celebrated Fantonus (h). And as he has given two of his own obfervations,
in opofition to their oppinion, fo you may alfo add others, not only from this
eleventh fection of the Sepulchretum, but even fome that are taken from
other places, and paticularly from the commentary of Brunnerus (/'). For
(e) Epift. 23. n. 2.
(/) De medic. 1. 4. c. 15. in princ,
(g) Seft. 4. aph. 26.
(/.>) De obferv. med. & anat. epift. 4.
(?) In pancr. fecund, c. 7.
Brun-
Letter XXXI. Article 14, 15. 75
Brunncrus faw, in a dyfenteric woman, the mouths of the glands of the duo-
denum " eroded :" and in others, who had labour'd under, a long flux of
the inteftines, he alio found " ulcers of a cancerous nature, as it were [k\u
and in one (/) who had been troubi'd with a cseliac flux, and in another (»),
who had been afllicted with a lientery, " an ulcerous difpofition," in the lair
mention'd patient, of the colon-, and in the former, throughout the whole tract
of the inteftines, he recko'n'd up " more than lixty little ulcers : " andthefe things
I was willing to take notice of, that you might know, what caufes may fome-
times happen, fo that the inteftines being irritated, where the ulcers are, by
the contact of the ingefta, which pafs that way, thefe ingefta may be fo much
the fooner expell'd, without giving time for the chyle to be perfected, or
even extracted, and that you might at the fame time conceive, if in thefe kinds
of fluxes, the inteftines are fometimes affected with ulcers, how much more eafily
they may be feiz'd with the fame diforders, where the violence of the pain is a
proof of there being fo much a greater degree of acrimony, I mean in the dy-
ientery. And left we mould feem to digrefs from our fubject, attend to two
obfervations of Valfalva's, that is, not only the one which is defcrib'd above (»),
of a young man, in whom a diarrhcea, without tormina, fucceeding to a dy-
ientery, he found the latter part of the ileum, and the firft part of the colon,
ulcerated ; but this alio which I fhall immediately fubjoin.
14. A man of thirty years of age, was feiz'd with a dyfentery. Thiscon-
tinu'da long time, till at length he was feiz'd with a fpitting of blood, and
with death.
In the belly, the fmall inteftines, indeed, were found to be unhurt : but
the large inteftines were, in fome places, ting'd with a black colour, and had
fome of their glands entirely eroded, the remaining glands being all drench'd
with a bloody humour, in the very excretory orifice. In the gall-bladder was
but little bile.
In the cavity of the thorax, towards the inferior part, was no fmall quan-
tity of blood extravafated. At the inferior part, alfo, the lungs were ftufF'd
up, and both lobes adher'd, on their fides, clofely to the pleura, which was
itfelf, likewife, evidently injur'd. The right ventricle of the heart contain'd
a polypous concretion.
15. The appearances of difeafe, which were found in the thorax, refer to
another fubiect. And, thofe in the belly, to the prefent. But as thefe things
which Valfalva has remark'd, of the glands of the inteftines, agree both with
thofe that you will fee produe'd from Peyerus, in this fection of the Sepulchre-
turn (0), and with thofe that you have feen in the firft, from among the obfer-
vations of Brunnerus,juft now pointed out (*)-, that one thing only, in regard to
little bile being found in the gall-bladder, would be contrary to the opinion of
Spigelius, if he, as fome learned men afTert, had pronoune'd the gall-bladder to
be " large in dyfenteric bodies," whereas he has only faid, that he had " fre-
" quently"feen itfo(/>). Yet, if we examine this whole fection narrowly, we fhall
fee it obferv'd but once by others. For Cummenus ($?), was the only perfon
W C. 10. (0) Schol. adobf. 4.
(/) C. 7. (*) N. 13.
(m) Exercit. de gland, in duodeno. §. 6. (/) De hum. corp. fabr. 1. 8. c. 13.
(*) N. 2. (q) Obf. I.
L 2 who
7 6 Book IH. Of Difeafes of the Belly.
who found " the gall-bladder to be very large, and very full of bile," and
in the body of a woman. Bontius (r), and Lamonjerius (s), found it to be
diftended indeed ; but the latter with pus, and the former with a white hu-
mour, " like a pultice of ftarch, lb that no traces of bile were left," where-
as Spigelius has declar'd, that the increas'd fize of it was owing to " the
*' quantity of bile, with which it was fill'd." But Francifcus Flaterus (/),
not only found it not diftended with bile, as others like wife feem to have
found it, who fay nothing upon the fubject, but even " quite empty."
Moreover, the patient of Platerus had the inteftines ulcerated, after a
dyfentery, which continued " lbme days •" and this I obferve, left you
fhould be apt to imagine, that this did not happen, but after dyfenteries of
long continuance. And there were innumerable little ulcers, for they took
up the whole extent of furface in the ileum, and were " the breadth of
" three fingers diftant from each other;" fo that this obfervation may
be, in fome meafure, compar'd with the obfervation of the celebrated Baf-
fius («), who, after a dyfentery, faw the fame interline diftinguifh'd with
ulcers, " at the diftance of almoft a finger's breadth from each other, and
" fometimes, at the diftance of a joint of the thumb, proceeding nearly in
" one tract, or feries," as the figure which he added (*), has alio exprefs'd
(except that he feems rather to have reprefented the jejunum, than the ileum)
confirming the defcription, in which the fame opinions, of Peyerus, that I
pointed out a little while ago, are ftrengthen'd by a probable conjecture, I
mean that, as thofe bodies, which he call'd glandular plexuffes, were want-
ing, and as every ulcer feem'd to occupy one of the feats of thefe glandular
plexufTes, it was very fuppofable, that the beginnings of the erofions, had
been in the fame plexuffes, which were, at length, entirely confum'd.
Nay, indeed Brunnerus, in that obfervation (jy), wherein he number'd
more than fixty little ulcers, has teftified that thefe ulcers, *' had their filia-
tion in no other part, than in thefe plexuffes." And certainly, that in in-
teftinal fluxes, the humours are thrown upon the inteftines, by thefe, or other
glands, may be even argued from their magnitude being increas'd, as hap-
pens in all other glands whatever, while their fecretions are greater than
ufiial. Thus in the body, wherein, after a long inteftinal flux, the fame
Brunnerus found ulcers, about the extremity of the jejunum (z), he not only
faw " glandular tuberosities," in that part likewife, but alfo found the in-
ternal coat of the inteftine, become much thicker, than it naturally is, and
this coat " feem'd, from the beginning, to the end, to be entirely glandu-
" lar and luxuriant with glands." And of his glands of the duodenum he
fays (a), " they are generally found to be much thicken'd, in thofe who die
" of difeafes in the inteftines, fuch as a diarrhoea, or a dyfentery :" and he
fays that the fame glands, had even " become indurated (£)," in that dyfen-
teric woman, in whofe body he faw the orifices of them " eroded," as Ihave
already faid.
(r) Obf. 6. (y) Supra ad. n. 13.
(/) Obf. 10. , (2) C. 7. ibid. cit.
(t) Inaddit. obf. 3. (a) In earum demonflr. anatom.
(a) Obf. ar.at. chir. med. dec 3. obf. 7, (i) Ibid.
[x) Tab. xi. fig. 1.
4 16. How-
Letter XXXI. Article 16, 17. 77
16. However, this lail obfervation of Brunnerus, and the two which 1 re-
lated a little before (r)» from Platerus, and Bafllus, and a part of that
which was given from Yallalva, in the beginning of this letter (W), even ot
themfelves, fufficiently fhow it to have been too haftily pronoune'd by LJa-
narolus, as you have it here in the Scpulchretum (<?), " that an excoriation,
" and corrofion, could not be brought on in the upper interlines of dyfen-
" teric patients, as happens in the large inteftines, and particularly in the
" colon." I confefs indeed, that in mod of the obfervations, among which
are even thofe two of the celebrated Fantonus (f), it was found to be fo,
and I fhould readily believe Panarolus, when he fays that it was equally fo,
in the difiection of all that confiderable number of thofe " bodies," to which
he refers : and I fliall alio agree with his reafoning upon the fubje£t., that a
corroding humour may very eafily flow on, in the fmall inteftines-, but that
in the colon, it as eafily ftagnates, by reafon of the cells : and I would
even add, that a corroding humour is often tempcr'd, and made much mil-
der, in the fmall inteftines, by the mixture of chyle, and more often by a
mixture of the watery, and mucilaginous, portion of the remedies, that are
taken in ; but that the humour goes down into the large inteftines, after thefe
meliorating fluids have, chiefly, been taken up, by the chyliferous veiTels.
All thefe things, I fay, I fee and confefs : nevertheless, to omit other methods
of reafoning, by which I might Ihow, that the very oppofite fuppofition may
fometimes take place ; there can be no force of reafoning fufficient, I do
not fay, but there can even be no number of obfervations, whatever, fuffi-
cient, to prove that what has been really feen, at any one time, cannot come
to pais.
17. But whether there are ulcers in the fmall, or in the large inteftines-,
it fufficiently appears, from all thefe obfervations, that the inteftines were
really ulcerated, in thofe dyfenteric bodies, from which they were taken. Yet
in thofe dyfenteric patients, whom we have it not in our power to diftecl, are
we alfo to fuppofe ulcerations for this reafon, that, as Celfus fays (g), they
have difcharg'd fome kind of mucous portions, with blood, and fometimes
portions of fle(h, as it were ? it is worth while accurately to confider this
queftion. And formerly, indeed, they did not doubt, but from the very
beginning of this difeafe, fome fat bodies were excreted, which they fup-
pos'd to be the internal fat of the inteftines. But this error was refuted, by
thofe who demonftrated that the fat was not on the internal, but on the exter-
nal, furface of the inteftines, and with them by Cafpar Hoffmann (h)9 who alfo
fhow'd that a certain whitifh body which had been difcharg'd from the in-
teftines, and was brought to him in a dry'd ftate, was taken for fat without
reafon, becaufe it did not, in the leaft, take flame, when applied to a
flame, and emitted a fmoke which was perfectly inodorous. At prefent,
however, as fome fubftances, which were difcharg'd in the fame manner, have
been found to be really adipofe, from an experiment of this kind made by
Tulpius (z), and Stalpart (£), there are not wanting learned men, who teach
(V) N. 15. (g) Supra ibid.
(d) N. 2. (£) Apolog. pro gal. 1. 2. f. 4. c. 122.
{e) Obf. 15. (/) Obf. med. 1. 3. c. iS.
(f) Supra, n. 13. \k) Cent. 1. obf. 61-
that
7 8 Book III. Of Difeafes of the Belly.
that they mud, " without doubt," have proceeded from the fat, which is
on the external cellular coat of the inteftine.
Yet to me, where there is no fufpicion either of confumptive coliiquation,
or of a deep ulceration of the inteftines, it will feem lefs improbable to account
for thefe difcharges of fat, in concert with Stalpart, and Riverius, whom he
quotes (/), from fat being plentifully eaten, and not concocted ; though I
might, perhaps, allow of fat being brought, quite from that cellular coat,
when I have found that there are ulcers, which open a paffage fufficient
for this fat to get into the cavity of the inteftines, provided it be cer-
tain, that this fat does not then come forth, in the form of pus, or ichor.
But becaufe the inteftines are ulcerated ; much more feldom in dyfenteries,
and much later in the courle of the difeafe, than this white matter, which
was fuppos'd to be fat, appears-, what fhall we then fay it is, or from
whence fhall we fay it proceeds ? "Without doubt it muft be mucous, as
Celfus alfo call'd it, agreeably to what I have faid a little while ago, and as
the moderns call it, if it be not very thick; but if it be very thick, we muft
even fuppofe it to be polypous.
For, as the glands of the bladder, when irritated, fecrete a greater quan-
tity of humour, and not of the fame nature with that which they fecrete in
perfect health, fo the glands of the inteftines, likewife, fecrete a greater
quantity of humours, and of a different nature •, for which reafon, in both
cafes, a white and mucous matter appears. But if there be, moreover, that
difpofition, in the blood, of eafily coalefcing into polypi, this humour will
be more prone to concretion •, and that fo much the more, where blood of
this kind having exfuded, or having been extravafated into the cavity of the
inteftines, has been added thereto. For thus, while a part of the blood
fhall remain in the cells of the colon, the watery part being taken up, and
the red part fubfiding, thofe fibres of the blood, as they are call'd, which
will be left behind, may be eafily compacted into polypous concretions, and
by reafon of their whitenefs, when, foon after, difcharg'd with the excre-
ments, may be taken for fat here alfo, as they were, formerly, fo often in
the heart and the veffels, where they belied the appearances of veffels, and
organiz'd parts, and deceiv'd the infpectors.
1 8. In either of thefe ways then, or in both of them, or even in any
other way, among thofe that Lancifi has pointed out (w), according to the
various conftitution of the patient, and according to the various nature of
the difeafe, and, finally, according to the time, place, and manner, in which the
lentefcent matter is retain'd, and difpos'd, not only the origin of thofe fat
bodies, as they feem'dto be, but alfo of the fhreds of membranes, and even
of large membranes that are faid to have been difcharg'd, may be under-
ftood, and the origin of fome of thofe bodies, that are call'd flefhy by Cel-
fus, may be very eafily accounted for, that is to fay, if the whole portion of
red blood be not prefs'd out, from its white, and coalefcent, fibres. And from
hence you may alfo perceive, how cautioufly we ought to ufe that prediction
of Hippocrates («) : " if a perfon labouring under a dyfentery, difcharge a
" kind of caruncles, as it were, 'tis a mortal fign :'" nor, indeed, was this
(/) In fchol. ibid. (») Diff. de tripl. inteft. polypo. (/;) S. 4. aph. 26.
4 caution
Letter XXXI. Article 19. 79
caution overlook'^, by him who treated, with great perfpicuity, of polypi,
I mean the very learned Pafta (o).
But that which we now call a mucous, or polypous, matter, the ancients
were, in general, accuilom'd to call pituitous, and vifcid, and Tome of thefe
were even us'd to acknowledge thole things, which I at prefent infill on.
Thus not to turn to the moll ancient of all, I obferve that Jacobus Berenga-
rius (p) has written the following words : " and I myfelf have fetn, that
M concretions, like pieces of thick leather, have been generated in my intef-
" tines, from pituita, and in like manner, a pituitous flefh, in fome meafure
" red, and equal, in fize, to a pretty large nut." And Fernelius fuppos'd
the matter of a firm body, which was a foot in length, and piere'd
through with a middle duct, to be of the fame kind -, which body was dif-
charg'd by the ambafiador of the emperor Charles the fifth, who was, by
that means, reflor'd to his former health. I fay nothing of Gabucinus and
Platerus, whofe opinion was taken notice of by Sennertus (r), nor was un-
known to Lancifi, when he readHy confefs'd (j), that both of them had
afferted that before them, were no inftances of the tcenia, or tape-worm,
which is a kind of inteftinal worm.
But Sennertus himfelf, I commend flill more (t), becaufe he fuppos'd that
the membranes, which were difcharg'd, from dyfenteric patients, who re-
cover, were nothing more than " mucous excrements, that receive this form
*' in the interlines :" and that it was by no means necefiary, to fuppofe that
this mucus mould always be excreted, either in its own proper form, or
in the form of blood, mix'd with this mucus ; but that it may put on another
form ; for, fays he, " we fee every day, that the fibrous part of blood, when
" thrown into warm water, grows white."
Yet you fee how much nearer, that which Zollicofferus (u) did at length
more exprefly throw out, in the year 1685, comes to this point; I mean
when diicourfing of thofe polypi, which are found without the blood veMels,
or refervoirs, and among them, of a polypus then found by Sponius, in the
pelvis of the kidney, *' to which clafs," fays he, " even that pituitous con-
" cretion might perhaps be refer'd which Julius Lipfius difcharg'd by
" llool, in the fhape of the inteilines, and believ'd to be the very intef-
" teflines themfelves." And this opinion was at length very particularly,
and clearly illuftrated, and confirm'd, by Lancifi, in many different ways,
and not after the manner of one who had any doubts upon the fubjecl.
19. It appears therefore, that in a dyfentery, bodies confifling of fat in
appearance, and bodies feemingly flefhy, and membranous, may be equally
difcharg'd from the interlines, without any ulcer having affecled them : al-
though Sennertus (x) denies, that he and Crato " could ever fee fuch mem-
" branes, and jagged pieces of membranes, as others defcribe," even where
there were ulcers. For thefe, certainly, had been feen, in thofe patients,
whofe recoveries defcrib'd by Meichfnerus fjy), and Saxonia, feem'd to him
(0) In not. ad hunc aphor. (/) Qu. cit.
(p) Super, anat. mundin. comm. 7. (u) DifT. de polypo cord. §. 6.
(7) Pathol. 1. 6. c. 9. (V) Qu. cit.
(r) Medic, praft. 1. 3. p. 2. f. 2. c.7. qu. 3. (j) Apud Schenck. obf. med. 1. 3. ubi de
(s) Difl". cit. epift. 2. ad Bianciard. dyffent. cur. obf. 4.
but
So Book III. Of Difeafes of the Belly.
but little credible. For the patient of the former, had often difcharg'd, to-
gether with pus, membranes " of the length of a fpan," and the patient of
the latter, a membrane from the ulcerated rectum, " of the length of an ell.**
Indeed in this pantheon, which Sennertus quotes, I mould fuppofe that
what is publifh'd under his name (z), deferves but little to be attended to, after
the juft complaints of Saxonia, againft the publifher of it, Uffenbachius (a),
efpecially as in the practical lectures of Saxonia, which were afterwards pub-
lifh'd here, nothing of that kind has been found by me, but this only (b) -t
with which Sennertus is alfo difpleas'd •, that Saxonia " had feen four dyfen-
*' teric patients, in whom fo large portions of the inteftines were, every
" day, excreted, that they often exceeded the meafure of three or four
" inches," out of whom two women recovered. And one of thefe perhaps
was fhe who, as Cafpar Hoffmann (c) fays, was fhown to him at Padua, by
his praeceptor Saxonia, and who, in a dyfentery, had difcharg'd a part of
the inteftine to the " length of a fpan," that is, as I fuppofe, if all thefe
excreted portions were fuppos'd to be jcfm'd together. Yet there Sennertus
■has done extremely well in openly confeffing, " that many things might
•" happen, which he had not feen." And indeed, if a very few years had been
added to his life, he would have read the obfervation of Tulpius (d), who
faw it happen from fevere pains, and ulceration of the inteftines, that the
whole internal membrane of the rectum was feparated from the inteftine, in
fuch a manner, that being pendulous from the inteftine, it might be feen by
him and by many phyficians, for two or three days together, its total fepa-
ration being for fome time prevented, by a firm adhefion, to the parts about
the anus.
It alio happen'd to me here, on the firft of June, in the year 1729, that I
was earneftly defir'd to affift with my advice, one Jacob del Vecchio, a Jew
merchant, on account of a fimilarcafe. This man had been attack'd with a
very troublefome pain at the rectum, in the decline of a malignant fever,
together with a fenfe of weight, and obftruction : and finally, a thickifh kind
of membrane, as it feem'd, had lately begun to come out from the anus,
which I faw hanging from thence •, its length was equal to the breadth of fix
fingers, and its width exceeded an inch, its colour was cineritious, degene-
ratino- into livid, like that of membranes, which are affected with gangrene:
yet it did not fall off, in confequence of being continued within the intef-
tine, and connected to it, as far as the furgeon could obferve, by examining
very gently •, for although, from the time of its exit, the pain was become
milder, yet the blood iffued forth now and then, and the fever was more
considerable at that hour, than it had been in the morning.
Wherefore, having fettled what feem'd proper to be done, in concert
with the phyfician of the patient, who was my fenior, I departed. And
from him I was inform'd, on the following days, that the membrane had
come away, being rather rtiptur'd, by the conftriction of the fphincter, as it
feem'd, than found: that blood, and an ill-condition'd ichor, had again
(s) Panth. 1. 3. c. 23. ut citat. Sennert. (e) C. 122. cit.'fupra ad. n. 17.
(a) Vid. Saxon, prasf. ad iibros 3. dePullib. (d) Oi>f. med. 1. 3. c. 17.
(I J P. 2. c. 19.
iffu'd
Letter XXXI. Article 20. 81
Iflucd out; and that a fingultus, which terrified every body, hard come on:
nevertheless, that he had fome little hope remaining, tor this reafon, becaufe
he remember'd that the father of the patient, who, when he was pretty far
advane'd in years, had had a fimilar, but a fhorter, membrane come from the
rectum, cfcap'd with life under his care, though with this inconvenience, that
he could never retain his excrements afterwards : and becaufe the fon, al-
though in the father no malignant fever had preceded, and no fingultus had
come on, was as yet fc3rcely five and forty years of age.
Nor was this well-realbning phyfician, whofe firname was Marina, de-
ceiv'd in his hope, with whom having again fettled thefe things which, as
the flate of the cafe then was, were neceffary to be added to the former, it
happen'd that a great quantity of pus being difcharg'd, I law the patient
out of bed, on the fixth day of July, now manifeftly recovering his ftrength,
colour, and habit of body, and not only retaining his faeces, but even heal-
ing injedlions, which were thrown up. There was fome pain indeed even
then ; but this was evidently more flight, nor was it any longer very trouble-
fome, in that fame fituation where it had been before. Wherefore this pa-
tient alio, as well as that of Tulpius, and others, whom, for the fake of
brevity, I purpofely pafs over, recover'd, and even was Hill living, and in
good health, when I dictated this hiftory, from my manufcripts, which was
about the end of the year 1747 (e).
20. But although it is very certain, that thefe patients efcap*d with life,
yet if you afk me whether it is equally certain, that they difcharg'd real
membranes, I (hall readily anfwer, no. Nor indeed do I fee that the na-
ture of them has been furHciently enquir'd into, which perhaps it was not
poflible for others alfo to do, as it was not polTible for me, in bodies that
were corrupted, and rotten, with putrefaction. And I fee, that even where
the inteftines are ulcerated, polypous concretions may be more readily
form'd in that place, either in a round form, fuch as Lancifi (f) has affirm'd
that he had feen difcharg'd by dyfenteric patients, equal to three or four
Ipans in length, or flat, in the form of a membrane, one of which kind the
celebrated Jofeph Ant. Pujatus (g) faw difcharg'd by a matron, who labour'd
under an ulcer of the rectum, the length of which membrane was almoit
equal to a fpan, and which he fufpected to be of the fame nature.
But as I deny that it is certain thofe former fubftances were membranes,
fo I deny its being certain that they were not membranes, and efpecially
thofe which feem'd to adhere to the inteftine, more than polypi are wont to
do. And to confefs my opinion to you openly •, I believe that any part of
the internal coat, of the inteftines, may be feparated by the force of difeafe,
and come away, juft as we often fee it happen to that thin membrane, with
which the parts of the mouth are inverted, from the contact of very hot ali-
ments. And this is certainly done without any, or at lead without any very
confiderable, effufion of blood, without convulfions, and other dangerous
Symptoms, which fome fear from the innumerable fmall veflels, and nerves,
that go to the internal coat of the inteftines, if this be really fuppos'd to be
feparated ; whereas a very great number of fmall veflels, and fmall nerves
alio, go to the internal coat of the mouth in like manner.
(e) Imo vid. etiam epift. 65. n. 6. (g) Dec. med. obf. n. 6. obf. 1.
(/) DifT. cit. epift. 1. ad Bianciard.
Vol. II. M Nor
82 Book III. Of Difeafcs of the Belly.
Nor would I have you fay, that the thin membrane which is then feparat-
ed in the mouth, is a continuation of the cuticle, or is at lead, proportion-
ably, correfpondent to it. For the fame perfon who call'd this epitbelia in
the prolabia and cheeks, fliow'd that there was a'fo a fimilar epitbelia in the
gula, (tomach and inteftines ; and this perfon was Ruyfch (b) : wherefore, if
you will not fuppofe me to fpeak of any other part, at ieaft fuppofe me to
fpeak of this, which the acrimony of the humours, or a fuperficial gan-
grene, after an inflammation, has loofen'd from the remaining part of the
internal coat, and left to be involv'd in the excrements, and carried down-
wards. But fometimes, you will fay, membranes which are depofited are
" pretty thick," r.s Saxonia fays (z) •, and the cuticle is thin. And fo it certain-
ly is, unlefs it be embrew'd with a large quantity of humours ; for hence the
celebrated Fantonus (k) judg'd it to happen, that we often fee it grow fo
very thick, from the uie of bliftering applications, as to become from
thence, according to his conjecture, divifible into many laminae, or to confifl
of a fpongy fubfeance.
But if ycu contend, that even in this way, the matter is not fufficiently
explain'd by me ; I then beg of you, in your turn, to explain to me the ob-
fervation of that very experiene'd furgeon Benevolo (I), of a membranous
canal being taken away from the anus, equal in length to fix inches, as
broad as the rectum generally is, and fo thick, that the fphincter ani feem'd
univerfally, or almoft univerfally, to have come away with this canal : and
indeed, it was neceliary to make ufe of medical, and chirurgical, reme-
dies, for almoft the fpace of a year, in order to heal up the ulcer of the
inteftine, and to remove the other inconveniences, which depended upon
the feparation of this tube, as well as to obviate the incapacity of re-
taining the excrements, which remain'd in confequence of this feparation.
For in the fame manner that you imagine you can conceive, how fo thick a
part of the inteftine could be feparated, without destroying life, you will
much more eafily conceive, how the internal coat which is fo much lefs
thick, may have been fometimes feparated. And if you readily allow of
this even in thofe who have recover'd, how much more readily muft you
allow of it in thofe who have perifti'd ? And if you had been prefent with
the foldier of whom Bontius fpeaks, or with thofe patients of whom Sylvius
fpeaks, each in this eleventh fection of the Sepulchretum. (mj, and had faid
that the membranes, which they, certainly, difcharg'd in a dyfenteric flux,
that was fatal to them, were really pieces of the internal coat ; do you think
you would have had reafon to retract your opinion upon opening their bo-
dies after death ? Not in the leaft. For you would have found, with Sylvius,
that the internal coat of the inteftine was, " here and there, abraded," and
with Bontius, that it was " quite abraded."
But was this abrafion univerfal ? What Bontius does not fay exprefly
enough, Piccolhominus (n) fays, in an obfervation, which, in whatever
way it is underftood, was certainly worthy to have been copied in the Sepul-
chretum. For he faw, " in a dyfenteric patient, who fuffer'd very excruciat-
" ing pains, and who always fhiver'd with a kind of horror, upon taking
(/>) Thef. anat. 7. n. 40. (/) 18. delle quaranta.
(/') C. 19. fupra ad n. 19. cit, \m) Obf. 6. & 16.
(/•) Anat. corp. hum. difl". 2. \>i) L. 2. anat. prasleft. 15.
" the
Letter XXXI. Article 2r. 83
" the fir ft. morfel of food, the whole Internal coat of the ftomach, and in-
" teftines, from the upper parts to the lower, (wonderful to fee, and to hear,
" and almoft too wonderful to be believ'd) abraded ; and that which was
" left, and appeared, feem'd flefliy, from the mouth of the ftomach, quite
" to the extremity of the rectum, lb that you would fay it was a kind of
" broad fafcia, universally flefhy •, and that the ftomach, alio, was a kind of
" bladder, as it were, univerfally flefhy." But of this obfervation mention will
alfo be made hereafter (c), "in which, as thole tilings, that he fubjoins foon after,
fhow, the author himfelf acknowledged an inflammation of the flefliy fibres.
zi. Now then, as it is more than iufficiently fliown above, that thole
bodies which are difcharg'd by dyfenteric patients, in the form of membranes,
fometimes are real membranes, but often are falfe membranes, and that they
are no proof of the interlines being ulcerated, unlefs they are found to be
real membranes •> it would remain to demon Urate the fame things, in pro-
portion, of thofe alfo, that are difcharg'd with a flefliy appearance, if it had
not been, already, Iufficiently fhown above (p), how polypi may, in like man-
ner, refemble thefe flefhy excrefcencies, or caruncles, without any ulceration
of the inteftines. One thing only, therefore, remains to be demonstrated; I
mean, that thefe bodies are not always entirely made up of a falfe flefh, and
when it fhall certainly appear, from the examination of them, that they are
lb, fome ulcer of the inteftines is then to be fuppos'd, provided there is r,o
fign of an ulcer in the ftomach : and this exception I make on account of
thofe verruc-c, as the Arabians call'd them, of which I have treated in the
twenty-ninth letter (q).
For although I have faid that flefliy excrefcences may exift there, without
ulceration •, I have not, however, denied that when they are broken off, and
come away, an ulcer is form'd in the place from whence they were torn;
and indeed that an ulcer muft happen in this cafe is a felf-evident propofi^
tion. Moreover I fpoke, at that time, of the ftomach, in fuch a manner, as
to allow what I faid to betransfer'd to the inteftines, and I even fufpefted that
a certain verruca of Avenzoar's, was not generated in the ftomach, but in the
colon that lies beneath it, on account of the bignefs which it feem'd to have
in the ftomach, if you prefs'd upon the epigaftric region. Which fufpicion
I am pleas'd here fo to confirm, by examples of the fame kind in general,
as to demonftrate, at length, that which I have advane'd.
Jo. Baptifta Cortefius (r), producing a paflage of Galen, from which it
may be underftood, not only that indurated feces, but alfo that " a bulk
*' of any body whatever, prsternaturally exifting in the inteftines," had al-
ready been reckon'd, by him, in the number of the caufes that obftruct the
bowels, has confirm'd the opinion of Galen, by this obfervation of his own,
which was made upon the body of the Count de Caldarinis, a nobleman of
Bologna. That is to fay, ".in the cavity of the colon, was found a large
" portion of flefh, which, by its bulk, was the caufe of impediment to the
" defcent of the feces, and by a diforder of this kind, which was a confe-
" quence of that obftruftion, the patient was carried off. Which caufe,
tc being, as the author himfelf fays, worthy of particular attention," I was
•willing to dtferibe in his own words, for this reafon alfo, be.caufe in the
(0 N. 26. (?) N. 16. & 17.
.,(/) N- l7' & l8- V) Mifcell. med. dec. 4. c. 8.
M 2 catalogue
84 Book II r. Of Difeafes of the Belly.
catalogue of thofe authors, whofe obfervations are transfer' d into the Sepul-
chretum, 1 have in vain fought after the name of Cortefius, as I did that of
Piccolhominus likewiie : neither is this oblervation found any-v/here in the
thirteenth fection, which is entitled De acljlritticne alvi ; but inflead of it, a
certain obfcrvation is taken notice of from Willis (j), as if it were certain
" that a kind of flefhy excrefcences, which adher'd to the larger inteftines,
*' like the ears of a moufe, coming out in great number, and in twins, from
*' both fides of the colon and rectum, and at certain diftances from each
" other, like the branches of a tree," as if, I fay, it were certain that thefe
were not on the external furface, as they feem to me to have been, and were,
perhaps, nothing elfe but the adipofe appendicles of the colon, and redtum,
in which, the fat being confum'd, the fanguiferous vefTels appear'd red ; for
thefe things Willis obferv'd in a confumptive man, and fays that he had
leen " fomewhat fimilar to this likewife in another confumptive body."
But, juft as if it had been certain, that thefe excrefcences had been on the
internal furface of the inteftines, and thus had brought on an aftriction of the
bowels, the cafe of a little boy is fubjoin'd in the fcholium, who, having dif-
charg'd a large flefhy mafs, that preferv'd the mark, by which it had adher'd to
the inteftines, was freed from an obftinate obftruclion of the bowels. But you,
however, by turning either to Willis, or to the other book of the Sepul-
chretum (/), in which the hiftory of that man is given more at large, will
not only be convine'd of what I have faid, but will, in particular, perceive
this, that in a man who was feiz'd " with a fpurious palfy, which affected
" every limb of the whole body," fo that he had fcarcely any power of
moving himfelf, there was no great occafion to afiign any other caufes be-
fides this, for the bowels being coftive, unlefs irritated.
But to return to the excrefcences, that certainly were in the cavity of the
colon •, befides that " flefhy" one, which I look for in vain, in the Sepul-
chretum, remark'd by Joannes Rhodius (u) in a monk, who, " being troub-
" led with colic pains, together with a vomiting of chyle, difcharg'd his
" glyfters back again, without any excrement," by reafon of " the colon
" being obftrudled by this flefhy excrefcence ■" there is an example of one,
which very peculiarly relates to the prefent queftion, in the fecond of thefe
two obfervations of the celebrated Fantonus, which I only mention'd
above (x).
In a man whom a violent dyfentery had, at length, carried ofly he found
" the colon ulcerated, not far from the caecum, from which flow'd a hu-
" mour of a purulent nature, mix'd with blood ; and there he found, be-
" fides this, a flefhy, thick and round body, almoft eight inches in length,
" which, taking its rife by a flender beginning, and being connected by
*' that only, as by a peduncle, to the ulcerated coat, had the other part of
" it pendulous in the inteftinal tube, and taking up the greater part of
" that tube: you would have faid, fays he, it was a large polypus of the
" inteftine •, for the whole of this body exceeded the weight of a medical
" pound." You fee that this excrefcence was attended with an ulcer, and
(s) Obf; i. §. 4. («) Aft. Hafn. vol. 4. p. 1. pag. 86.
(/) I. left. 13. obf. 1. (*) N. 13. & 16.
without
Letter XXXI. Article 22. 85
without doubt arofe from an ulceration being continu'd through this lon^
dyfentery : and it could not be call'cl a great polypus for this realbn, that n
had the nature of thole polypi, which are fpoken of above, but becauie it
refembled a polypus of the nofe, which is i'o call'd from its iimilitude to a
polypus, not only in its figure, but in its nature alio ; for this that fkilful
and cautious anatomift pronoune'd to be flefhy.
22. Yet I do not doubt, but excrefcences of the inteftines may fometimes
confiit of both natures •, as for inltance, if to flefhy fimbria.*, which are not
equal, or lmooth, on their furfaces,, particles of vifcid pus, or inteftinal juice,
or extravafated blood, begin to adhere : and to thefe others, and frill others,
are added afterwards, lb that the root and the nucleus may confiit of real
fiefh, but the body of the mafs that lies round it, or is added to it, and the ap-
pendages, may confiit of that which has the appearance of flefh, and is not
lb in effect.
I was confulted, in the year 1736, for a nobleman, who, after having fre-
quent difcharges of blood by ftool, join'd foon after, with a bilious flux of
the inteitincs, and with a continual fever, which was, at firlt, flight, and af-
ter that acute,, when this fever, and its violent fymptoms, did not at all re-
mit, from the ule of the moft fuitable remedies, and even when that fymp-
tom, which was more violent than any of the others, I mean the pain of
the belly, was of a fudden become extremely fevere, had difcharg'd, after a
great quantity of blood, and by the help of the furgeon's hand, a certain
body almoft of the length of a fpan and half, but of a different thicknefs, .
and figure, in different parts. For on the upper part, it refembled an ugly
head, as if that of a pretty large frog, with the mouth gaping •, the other
part of the body was almoft round externally, internally hollow, and was
two inches thick, till growing flender, by degrees, it terminated in a tail of a
confiderable length, and bifid, near its extremity.
If you remember what my opinion was, in almoft the latter end of the
preceding letter (jy), of frogs, toads, and lizards, being difcharg'd from the
inteftines, you will eafily imagine what I thought, when I read this account
that I have given you : nor was there any occafion, here, to fufpect what you
will read in the hiftory of a certain miller (2), whofe diffection is otherwife
worthy of inflection, on account of chylous excrements having been con-
ftantly difcharg'd, for a year and half together, and of being compar'd,. for
the fake of finding out the truth, with what I have hinted above (#), upon
the caeliac flux. But a toad was faid to have crept in at his mouth, when
he was afkep, and to have done much mifchief within, till at length it was
difcharg'd by ftool, in an over-grown ftate, and dead : which toad I could
wifh the excellent author of the obfervation had not been deter'd by the
very filthy, and noxious ftench, from attentively examining into, and not.
only by the eye, but with the affiftance of the knife.
As far, however, as relates to our cafe at leaft, the learned phyfician, alfo, .
by whom I was confulted, made no hefitaticn, in contempt of vulgar opini-
ons, to fuppofe that a body of this kind was of the nature of the polypi of
Lancifi. Yet, as befides the external fibrous ligaments, by which it leeni'd
(j) N. 21. (z) Eph. n. c. cent. 3. & 4. obf. 16 j. (a) N. 4.
tCr
5
'86 Book III. Of Difeafes of the Belly.
to have been connected with the inteftines, he defcrib'd a foft and diftractile
fubftance, almoftof a black colour, whereof it confided, and that made up
of pretty ftrong fibres, with various glands lying betwixt them ; and as he
mention'd that the blood, which had flow'd frequently before, to the quantity
of fome pints, had ceas'd to flow, upon the removal of that body, and that
purulent, whitifh, almoft cineritious, and extremely foetid, matter had fuc-
ceeded, which fometimes preceded the difcharge of the excrements, and
fometimes follow'd them, and always with very great pain, and that thefe
fymptoms, and the acute fever, had continu'd, till, vulnerary remedies being
given, which were afterwards fucceeded by ballamics, thefe, and the other
difagreeable fymptoms, were firft diminifh'd, and at length quite remov'd ;
fo that the patient (who liv'd many years after) defir'd nothing more of me,
than to advife fuch methods, as might tend to preferve him from the return
of this diforder : I was ready in my own mind to conjecture, that the begin-
ning, and roots, of this body were excrefcences, that had been form'd near
the extremity of the colon.
For this fituation was pointed out, by that very fevere pain, which, with-
out doubt, began below the navel, in the part where the colon generally has
a kind of flexure, before it terminates in the rectum, and from thence, fol-
lowing the adhefions of the mefocolon, was extended quite to the back. I
fuppos'd therefore, that thefe roots, when they began to be eroded, ulcerated,
and torn off, had pour'd out blood, and moreover, that when they were ul-
cerated pretty deeply, and all round about, the pain, and the other fymp-
toms, had come on : and that, in the mean while, the fibrous and other vif-
cid parts, of the blood, as it drip'd down, had adher'd to the excrefcences,
and increas'd their fize, and by this means brought them into contact with
each ether, and form'd them into that fhape, and appearance, which they
had, when entirely pull'd away, and difcharg'd. Yet as out of all the bo-
dies of this kind, that I have read of, as being difcharg'd from the anus, I
can at prefent call to mind only one, and that lpoken of by Peyerus (£),
which was " furnifh'd with blood-veflels •," and as where I plainly fee any
body to be furnifh'd with thefe vefiels, I fhall pronounce that it is, certainly,
to be refer'd to the clafs of excrefcences •, fo, on the other hand, as I very
■well know, how eafily we may be deceiv'd, and impos'd upon, in various
ways, by polypous concretions, I fhall anfwer only by fufpecting, and con-
jecturing fomething of this kind, in regard to the others, which either are
without thefe true vefiels, or are not acknowledg'd for true excrefcences, by
the judgment of a cautious and experiene'd furgeon.
Thus I formerly gave credit to Valfalva, when examining, in conjunction
with me, a bloody ichor that was difcharg'd by a dyfenteric patient, whofe
life was defpair'd of, and finding therein a kind of little fubftance, which, if
you confider'd only the colour, feem'd to be nothing but a fmall coagulum
of blood ; he, after enquiring into it very attentively, and con fide-ring it
thoroughly, pronoune'd, without any hefitation, that it was a fmall excref-
•cence of the ulcerated inteftine. So, alfo, I fhould have given credit to the
.(6) Exercit, I. tie gland, intcfiin. circa fir.cm.
• ■ 5 veiT
Letter XXXI. Article 23. 87
very fldlful Molinelli CO, if he had pronoune'd a hollow body, of a fpan in
length, which a man who was afflicted violently, and for a long time ti
ther, with a dyfentery, had himfelf drawn out from the reclaim, to be " .
" the fungous flelh of ulcers," though he, in confequence of his great pru-
dence, and caution, would by no means do this, but only laid, that k was
" not unlike" fuch a kind of flefli. And perhaps the celebrated StruviusfX)
had. his eye to nothing c'lfe, fince, when he delcrib'd " a memhranolb-carne-
" ous kind of nuis," as he exprefsly calls it, of equal length with the other,
of an inch in thicknefs, and " interwoven with a great quantity of fat,"
which was difcharg'd from the anus, by a very violent (training ; he was wil-
ling, as I iuppofe, to (hew his own doubts, by prefixing this title, Be Mafia
Pclyfcfa per ahum excreta, to his obfervation : and yet fuch things had pre-
ceded, as might have given, as well as the dyfentery itfelf, a juit fufpicion
of a flefby excrelccnce.
23. While I have been mowing thus far, that in a dyfentery, adipous,
membranous, and flefliy, bodies may be difcharg'd, and yet that the inteftines
are not ulcerated, for this reafon, becaufe theie bodies often feem to be whit
they are not} I have fear'd now and then, left you mould, perhaps, wonder,
that I do not feem to think an erofion, or rupture of vefTels to be prov'd,
even from the mere dilcharge of blood ; fo that an ulceration, either already
form'd, or at leaf!: begun, muft of courfe be acknowledg'd. Bun if you
have wonder'd, you will immediately ceafe to wonder, when you attend to
thofe things that I (hall touch upon in a few words.
There is an obfervation of the celebrated Wagner (e), in which, he not
only defcribes feveral appearances found by him, in the vifcera of a dyfen-
teric woman, and amongft thefe, that which ought to be remark'd in favour
of Spigelius (f), " that the gall-bladder was turgid," but this alio, in parti-
cular, that the inteftines had, no where, any marks of difeafe, except that
all " the fmall and large inteftines were equally ftrip'd of the mucous hu-
" mour, with which they are generally cover'd," and the rectum was gan-
grenous. But if he had obferv'd any little ulcer in thefe parts, he then
mould not have look'd for the pafTages of the blood, which the patient had
difcharg'd, in thofe extreme orifices of the veins, that is to fay, thofe which
the fcirrhous glands in the mefentery, and fpafms, had conftring'd, fo that
the blood " regurgitated immediately" through thofe orifices, into the in-
teftines, in the fame manner as a blue liquor, injected into the fame veins, did
then exhibit to him, " very evident marks of a blue fweat," within the in-
teftines.
Befides, there is an obfervation of Wharton, given by Gliffon, in his trea-
tife of the ftomach and inteftines, which, as it is defcrib'd fomewhat diffe-
rently from the intention of this treadle, in the Sepulchretum (g), without re-
ferring you to any particular part of it, will, if you read it in the twenty-third
chapter, under number eleven, (how, that after an " enormous vomiting of
" blood, from poifon, no vein in the ftomach," which, even after death, con-
tained a fmall quantity of blood," had appear'd to be either ruptiu'd or erod -
(<-) Vid. Comment, de bonon. fc. acad. t. 2. («) Eph. n. c. cent, i & 2. obf. 171.
p. 1. inter medica obf. 2. (f) Vid. fupra n. 15.
(d) A&. n. cur. t. 1. obf. 195. Qr) L. 3. f. 8. obf. 7. in additam.
ed,
88 Book III. Of Difeafcs of the Belly.
" ed, but that the internal coat being wip'd away with the back of the knife,
" innumerable little bloody points had then gradually appear'd, on the de-
" terg'd furface." But whether by a wiping of this kind, as Glifibn thinks,
a kind of cuticle, as it were, was abraded, and the poifon acled in no other
manner in the living body, as the internal coat itfelf was feen to be bloody,
juft as the cutis appears when the cuticle is abraded •, or whether it be more
probable that the extreme orifices of the arteries being dilated, by the quan-
tity of blood, which the violence of the poifon had brought together, had, a
little before, pour'd out the blood, and the back of the knife, at that time,
prefling out whatever blood remain'd in them, brought their orifices to view,
I would rather choofe you mould judge, from what Boerhaave (b) has faid,
in more than one place, of anaftomofis, than that I fhould determine.
Attend to the example which he there produces, and elfewhere alfo ; as,
for inftance, when fpeaking of the menftruous blood, which was retain'd, be-
ing difcharg'd by other patTages, he fays (i), " I have feen an hasmoptoe of
'* this kind, which had grown habitual, io that every month a florid blood
" was fpit up, without detriment to health, though join'd with a (light cough.
" I have feen the blood thrown up by vomiting : I have feen that it has been
" difcharg'd by ftool, and by fweat." Compare, moreover, with each of thefe,
the other examples, that the very learned Haller (k) adds, in a confiderable
number ; and in whichever you find this to have happen'd, " without detri-
" ment to the health," fuppofe it to have happen'd equally, without ulcera-
tion, juft as when blood was difcharg'd by fweat, you would have feen the
fkin, in that place, to have been very found, nor any other appearance there-
on, when deterg'd, but " thofe innumerable little bloody points," which
Wharton faw on the internal coat of the fbomach, when wip'd.
Now transfer thefe reafonings from the ftomach, to the interlines, and you
will conceive how blood may be difcharg'd, in a dyfentery, without any ulce-
ration of the inteftines, or, if you are a little in doubt on this head, put that
observation of Wharton out of the queftion, at preient, and befides the ex-
amples which I have given you, call to mind that of blood flowing from the
noftrils. Are the veins, or arteries, always either ruptur'd, or corroded, in
this cafe ? or is the coat of the noftrils always ulcerated ? If they are ruptur'd
or corroded, how does it happen that the blood often flops fpontaneoufly,
■without the leaft remedy being apply'd ? If they are ulcerated, how does it
happen, that no pus, I do not fay, but that even no pain is the confequence ?
Now then fuppofe it probable, that the fame thing may happen, on the inter-
nal coat of the inteftines, which you fuppofe to have happen'd on the inter-
nal coat of the noftrils, efpecially as the fluids, that are injected by the ar-
teries, are fo eafily carry'd through either of thefe coats, into the cavity of
the noftrils, or inteftines (/). Suppofe, therefore, that the quantity of blood
is increas'd, that the impetus of it is increas'd, and that the- extremities of
the arteries, on the internal furface of the inteftines, are made more lax than
ufual, and particularly in thofe in whom they were, before, naturally lax,
(b) Pra:le<5t. ad inftit. §.707. 775, 814, &c. (/) Vid. not. Haller. ad §. 497. earund.
(/) Ad §. 667. praleft.
{a) In not. ad cit. modo §.
either
Letter XXXI. Article 24, 25, 26. 89
either from a kind of paralytic affeclion, or from fome other caufe, a? for in
itance, from having been too much moiften'd, in fluxes of the intellines ; and
you will eaiily conceive with Boerhaave, that blood is difcharg'd from thence
by means of anaftomofis.
24. And you mull not fuppofe any one of thefe circumftances only to take
place, but many of them at once. For as Boerhaave thus teaches (m) : " when
" the blood cannot pafs through the vena portarum, and its branches, then
" pure blood itfelf may be extravafated by an anaftomofis, from the mefenteric
" veflels," if he had not immediately added " the orifices of which are dilat-
" ed," any one might doubt upon the event, who had read that Ortlobius («),
when he made a ligature upon this vein, in living dogs, " could never ob-
" ferve that pure blood burft forth on the inteftines, notwithftanding the.
" whole coat of the inteftines was dy'd, as it were, with a fcarlet colour."
In thefe dogs, without doubt, the mouths of the veflels were not dilated.
But they were very confiderably dilated, by reafon of the laxity of the fur-
rounding fibres, " in the fphacelated inteftines" of that count, of whom this-
author fpeaks ; for in the inteftines of this gentleman he faw, " the meferaic
" veins having their orifices open, and fill'd with coagulated blood, as if
" they had been fill'd with wax." And thefe things I hinted, becaufe in a
dyfentery, " fome times there is a true inflammation, and a fatal gangrene
" follows," as Boerhaave has faid a little after thofe things that I have relat-
ed (0). And indeed the obfervations of many authors, in this eleventh fec-
tion of the Sepulchretum (/>), fhow that he has faid what is true ; and be-
fides that which is produe'd above (? ), this other of Valfalva's, alfo, con-
firms it.
25. A woman died of a dyfentery. The inteftines were found to be inflam'd.
The left kidney was altogether deficient in this woman : but the deficiency
was fupply'd by the right, which was twice as large as it naturally is, and
furnifh'd with a double pelvis, and double ureter. And both of the ureters
went to the right fide of the bladder.
26. Setting afide thofe appearances which, as it is evident to you, muft
have exifted from the original formation of the woman ; the inflammation of
the inteftines relates to the dyfentery. Now then call back to your memory,
and join with this obfervation, and with others, that which I have defcrib'd
above from Piccolhominus (r). For in that, whether the abrafion, which
feem'd fo far furprizing to the obfervator himfelf, was very great ; or rather,
whether a confiderable inflammation of that kind was join'd with the abrafion,
fo that the whole coat of the inteftines was red, as it was in the dogs of
Ortlobius (s) •, there is no doubt but Piccolhominus, alio, acknowledg'd an
inflammation. And as this cannot happen, but the paflTage of the blood,
through thofe branches of the vena portarum, muft be fuppos'd to be im-
peded ; I have already faid (t) what may be the natural conlequence of this,
if any other caufe be added, even before the inteftines, by the impetus of
the blood ftill continuing, begin to degenerate into a gangrenous laxity.
(«) Ad §. cit. 814. (?) N. 14.
{«) Hilt, part. & cecon. horn, cliff. 8. $. 7. {>) N. 20.
(0) Ad §. 815. (s) Supra, n. 24.
(/) 3- 9- '9- §• 1 & 2. (/) Ibid.
Vol. II. N Thus
90 Book III. Of Difeafes of the Belly.
Thus Brunnerus («), in a foldier, who had been rarry'd off by very vio-
lent convulfions, which came on, when he already labour'd under a diarrhoea,
found through the whole tracTb of the inteftines, and efpecially the fmaller
ones, a confiderable inflammation, from which even the ftomach was not
altogether free, and, at the fame time, coagula of blood in the laft-mention'd
cavity, and in the inteftines a red mucus, which was a very evident proof,
that the diarrhoea had, already, begun to degenerate into a dyfentery, al-
though as yet nothing gangrenous appear'd in thefe vifcera. And an inflam-
mation of the inteftines may eafily pals over into a gangrene, and even into a
fphacelus, as I have faid : from whence it probably happens, as was related to
me, by a very experienc'd phyfician, when I was a young man, that it is not
uncommon for the fever, in dyfenteric patients, to leem to be quite gone
of?, for a few days before death, fo that a phyfician, if he did not attend to
other fymptoms, might be fhamefully deceiv'd. However, in regard to that
very fallacious diforder of the inteftines, the fphacelus, I fhall have a more
convenient opportunity of treating of it hereafter (x).
Now in refpect to membranes being difcharg'd, either together with blood,
or together with pus, or with neither, and thefe either in a dyfentery, or
when there is no dyfentery, fomewhat is to be added to thofe things that I
have faid above. Without doubt I have wifh'd, that the nature of fome of
thefe membranes might have been examin'd into, more accurately. Lenti-
lius (y) for inftance, has exceedingly well determin'd, what inteftine it was,
from whence the membranes proceeded, which were excreted in the ftools at
intervals, with or without blood, and in a greater, or in a leffer number.
But as to his fuppofing thefe membranes to be the valvular conniventes, every
one is at liberty to give credit, or not give credit, to his fuppofition •, and
even to believe, or difbelieve, this very circumftance alfo, that they were real
membranes. For it appears that he was abfent from the patient, and couldt
have ieen nothing elfe, but that they were " of a different fize, and that,
" when dried, they reiembled the pellicles of a hog's bladder, when fhrivel'd
up with heat."
But Jo. Maurice Hoffmann (z), when he examin'd very attentively mem-
branes that were excreted by another woman, which every other perfon had
taken for the internal coat of the inteftines, found them to be a vifcid mucus,
*' coagulated upon the valvular conniventes, and condens'd into the form of
" a membrane :" nor does the opinion of the celebrated Traslingius, in the
fifth volume of the Acta Naturae Curioforum (^), differ from this: for he,
on examining a kind of tube, or {heath, difcharg'd by the wife of a peafant,
found it to be not really membranous, " although it refembled the figure
" of the colon, with its valvuke conniventes." On the contrary, Apinus (b)
made not the leaft doubt, but the membranes, which were difcharg'd by an-
other patient, were really pieces of the internal coat : and indeed he has pro-
duc'd many reafons, even from the infpection of them, why he mould be be-
liev'd : although the reafon which he gave in the firft place, that they were
(u) Exercit. de gland, duoden. §. 4, (%) Dec. ead. a. 9 & 10. obf. 60.
(*) Epift. 35. (a) Obf. 126.
(y) Eph. n. c. dec 3. a. 3. in append, n. 6. \b) Dec. cit. a. 9 & 10. obf. 179.
ad obf. 68.
" of
Letter XXXf. Article 26. 91
" of a form exactly tubular," is not only render'd of no eficcl, by the ob-
fervation which was juit now quoted, but alio by the obfervation of the cele-
brated Verdrielius (r), who having examin'd, very clofely, one difcharg'd by
another patient, found it, very evidently, to be nothing elfe but " a fiftu-
" lous pituita, which had concreted together, and accommodated itfelf to
" the figure of the inteftine, wherein it was contain'd."
But mu ft we fuppofe, you will fay, that the fame thing happen'd within
the inteftine cecum, which Beckerus (d) almoft affirm'd formerly, his hav-
ing feen difcharg'd by ftool •, that is to fay, " a membranous body, equal in
" length, and breadth, to the finger of a large man, open, and eroded, at one
" end, and at the other end fhut ? For he has immediately fubjoin'd the fol-
lowing words, " made up of a threefold coat, thin, flefhy, and rufous."
Nay, and to go farther, what fliall we fay to three other obfervations, in
which not the appendix vermiformis, that is on the fide of the inteftine, for
inftance, but a confiderable part of the tube of the inteftines itfelf, is faid to
have been difcharg'd by the anus ? I heartily wifh that George Francus (e) had
been permitted (for his patient did not furvive, as thole of Beckerus, and
others did, but died a few hours after the difcharge of it) to examine the bo-
dy, after death, in order to determine the fituation, from whence, " an en-
" tire part of the fmall inteftines, of the length of a fpan, and what was
" more, with a portion of the mefentery, (till annex'd to it," had been torn
away, which he, by reafon of the valvulae conniventes, wherewith it was
internally furnifh'd, fuipe&ed to be from the jejunum: although if a lepa-
ration of this kind is to be wonder'd at, the coalition, which we mull, of
courie, fuppofe to have taken place, in two other patients, betwixt thole
parts of the inteftine, from whence the intermediate portion was torn away*
is ilill more to be wonder'd at, fince neither of thefe perfons, if a paffage had
been left open, from the inteftines, into the cavity of the belly, could have
furviv'd.
But Jo. Peter Albrecht (f), and Andreus Weftphal (g), when they pro-
due'd their hiftories, ingenioufly imagin'd, that an intufufception had preced-
ed, or a prolapfus of the inverted part of the fuperior inteftine, within the
part next below ; fo that a tearing away of the prolaps'd part did not happen,
by means of inflammation, and gangrene, before there was fome congluti-
nation in the place of the feparation, betwixt the receiving, and the receiv'd
inteftine. For as to that which was difcharg'd, being actually a portion of
the inteftine, although " many doubted" in regard to the firft observation,
and in regard to the fecond Bruckmann, and Hoffmann, fuppos'd it to be,
cither only a coat of the inteftine, or a mucus in the form of a coat ; yet
witnefies of the firft being really fo were not wanting, and other learned
men, and in particular the magnific order of phyficians at Gripfwald, to
whom what was difcharg'd, in the fecond obfervation, is laid to have been
fent to be examiirM, have pronoune'd that to be reaL
(0 Ephem. eanmd. cent. i. obf. 90. (f) Dec. ead. a. 3. obf. 129.
(</) Earund. dec. 1. a. 4. obf. 68. (g) Difput. qua; partem inteft. jejuni, Sec
(r) Earund. dec. 3. a. 5 & 6. obf. 177.
-N 2 One
92 Book III. Of Difeafes of the Belly.
One thing I have obferv'd, which may feem to correfpond but indifferently,
in either of them, to the fuppos'd intufufception. For the valves, in the in-
verted inteftine, mould have been found not on the " internal" furface, as
they fuppofe, but on the external furface, nor mould any portion of the me-
fentery, or omentum, adhere "externally," but internally : although it may
be faid, that the furfaces were not fpoken of, as they then were, but as they
had been before, in their natural ftate, or that the inteftine had been turn'd
back into its former ftate, either while it was carry'd down, through the re-
maining part of the canal, quite to the anus, or while it pafs'd through
the ftreight paflage of the anus itfelf, or at length, even by the hands of
thofe who had examin'd it after it was difcharg'd. Be this as it will, when
you have read, and confider'd, all thefe circumftances, you will judge what
, credit is to be given to theie obfervations : for in regard to me, you are quite
at your liberty, to take part either with thofe who believe, or with thofe who
doubt, or with thofe who, in fome meafure, confent therewith ; and I fup-
pofe you will be lefs furpriz'd hereafter, if you hear that any dyfenteric pa-
tients have recover'd, even after they have difcharg'd real membranes, or
caruncles, from the inteftines.
27. Although I have written much more upon the fubjedt of the dyfentery,
than I had determin'd in the beginning, yet before I come to a conclufion, I
have a mind to add fomething on the fubject of tenefmus ; not in the man-
ner I fee it is here done in the Sepulchretum (£), where it is confider'd as
arifing from other caufes, of which I fhall fpeak on a future occafion, but
only when it is brought on by the dyfentery. I believe, indeed, that in the
end of this flux, the caufe by which the rectum is irritated to difcharge its
contents, does frequently not confift in the diforder of the fame inteftine,
but proceeds from the remains of the acrid mucus, and blood, ftagnating
in the neareft cells of the colon, efpecially if there be the obfolete colour
of this blood mix'd with the mucus, and it being carry'd down, by de-
grees, through this inteftine, and, in like manner, through the rectum, to
the lower part of it, which is very impatient of irritation.
It is furprizing to confider how long fome fubftances, even when in no
fmall quantity, nor in themfelves vifcid, feem to have been retained in the
cells of the colon. Inquiry was made of me, in the year 1744, in the name
of a learned, and ingenious, phyfician, where I thought that peafe could
pofiibly have remain'd in the belly of a man, five whole months after being
eaten ? For he afferted, that there was a man, in his city, who having eaten
them frequently, and in large quantities, in the month of June, and being
feiz'd in October with a dyfentery, and fingultus, could not be cur'd of thefe
diforders, till, in the beginning of December, he had difcharg'd by ftool,
two pounds of peafe, which were fo entire, that many of them were pre-
ferv'd as curiofities by admiring phyficians. And it was faid that the fame thing
had happen'd to the father of this man before, only they had not remain'd fo
many months. I anfwer'd, that if this* relation were true-, for as the ftory
was well-known in that city, and teftify'd by many, I could not fairly difpute
the truth of it, efpecially as I had read hiftories, in medical authors, which.
{b) Obf. 79. k feq.
were
Letter XXXI. Article 28. 93
were much more difRctlt to be fuppos'd ; and if thefe two men had the fame
ltructure of the itomach, and inteilincs, that others had, 1 did not fee how
they could fo eafily have adher'd, as by being . difpers'd into many cells of
the colon: tor if rhey had been join'd together, they would have obftructed
the pailagc through this inteftine, and Hill more through the fmall inteftines,
and would have been very burdenfome, and uneafy, to the ltomach, as they
were in fo very conliderable a quantity, and, as appear'd from the circum-
flances, unbroken with the teeth, and perhaps not lufficiently boil'd before,
nor in a green, and tender ftate, but already grown old, yellow, and hard.
That there cells probably were, in thefe men, naturally fomewhat larger than
they are in others, and confuted of more lax fibres, but that there was fcarce-
ly any doubt of very vifcid, and tenacious, matter having been contain'd in
the tube of the inteftines, in confiderable quantity, and that in confequence
of their being accuftom'd to mafticate their food fo little ; and that the peas
being entangled by this matter, and glued, as it were, to the parietes of the
cells, had remain'd in this ftate of adhefion, till they were, at length, loofen'd,
and remov'd, from thence, by the tormina of the dyfentery, and the frequent
ftrainiigs to ftool.
28. But although in explaining that tenefmus, which fucceeds a dyfentery,
I am often, as you have feen, fo far of opinion with Sydenham (z), that I
do not allow of an ulcer exifting in the rectum ; yet do not imagine that I fo
far adhere to his opinion, as not to fear fometimes, left an ulcer, or fome
other confiderable diforder, fhould be the confequence of a dyfentery ; as I
was warn'd, even when I was a young man, by the event of a certain pain
in that inteftine, after a dyfentery, upon the caufe of which my preceptors
had opinions different from each other.
For as in a woman of the firft rank, a dyfentery had ceas'd, of itfelf, after
about fifteen days, and fhe always complain'd of a pain in the lower part
of the inteftine, when fhe had occafion to go to ftool, and at other times alfo,
join'd now and then, with a kind of troublefome pricking ; one of them fup-
pos'd that this arofe, as it was in a delicate woman, only from a flight abra-
fion of the internal coat ; and the other, that is Albertini, who obierv'd a
continual fenie of weight to be join'd with that pain, befides a fever, not with-
out a kind of conient in the thighs, and the lower part of the loins, but no
tenefmus, or fcarcely any •, was afraid of fomething of greater confequence,
till at length her fever, being increas'd, with a rigor, he openly foretold the
fpeedy appearance of an abfeefs. Which prediction was foon confirm'd by
the event, pus being difcharg'd to the quantity of two ounces, and the phy-
fician who had difTented, as he was an ingenuous old man, not only confef-
fing it, but what few can fubmit to, even commending the true prediction
of the other.
Eut in regard to a very confiderable diforder of the fame inteftine, and one
that is lefs known among the common people, I fhall have occafion to fpeak-
of it in the next letter (£). Farewell.
0
(0. C/bf. med. circa moth, acut, f. 4. c. 3, (i) N. 6. Scieq.
HETTER
94- Book III. Of Difeafes of the Belly.
LETTER the THIRTY-SECOND
Treats of Coflivenefs and of the Piles.
THE oppofite diforder to that of which I lately wrote to you, I mean
the diforder of coflivenefs, I have obferv'd in many perfons, without
^ny evident detriment to health, notwithstanding fome are accuftom'd to have
no difcharges from the bowels, for weeks together, and even (as our cele-
brated Zeviani (a) has alfo obferv'd) for a month together, and at other
times, and that more frequently, join'd with manifeft injury, of which death
itfelf was the conlequence. Neverthelefs, I have but one obfervation of this
diforder, which is join'd with a diffection, to defcribe to you here : for the
other observations of this kind, as they were join'd with vomitings, volvu-
lus, and other diforders of that kind, it did not feem proper to disjoin from
them. And if the fame thing were, likewife, done in the Sepulchretum, the
obfervations of this thirteenth fection would be greatly reduc'd in their
number.
For you will fee it remark'd in mod of them, in what other fection that
part of the obfervation may be read, that has been taken away from this.
But that there are others, in which the fame remark ought to be made, three
pages only, the hundred and ninety-third, the hundred and ninety-feventh,
and the two hundred and third, if you turn to them, will clearly demon-
ftrate. For if you read in the firft, the fecond article of the third obferva-
tion, yen will naturally fuppofe that it belongs only to that place. But the
third article will immediately fhow you, that the fame is given twice over,
and ftill more, that what is deficient in both, is to be fought for elfewhere,
that is in the eighth fection of this book, in obfervation the fifteenth.
A fimilar repetition will be prov'd, in the fecond of thofe pages I refer'd
to, by comparing the fecond article, of the ninth obfervation, with the eighth
article of the fame j for we are not to fuppofe, that becaufe by a fhameful ty-
pographical error in the letter it is faid " in the left fide under the region of
*' the liver:" the cafe is not the fame which in the former is properly de-
fcrib'J, by laying, " in the right fide," for that it is fo, will be clearly de-
monftrated to you, by turning to the next, that is the fourteenth fection,
which is there refer'd to, and in which this hiftory is given, fomewhat more
at large, under article the firft of the eighth obfervation.
Finally, the third of thole pages that I pointed out, will immediately (how
avhat is repeated, and what is neverthelefs omitted, when you mall have
(a J Del flaw, &c. I. z. c. ij.
•■; coin-
Letter XXXII. Article 2.
95
comparM article the ninth of the twelfth obfervation, with article the third,
and both of them with the feventh ieclion, to which you are in the letter
defir'd to turn, where you will read the cafe defcrib'd more at large, under
obfervation the thirty-third.
But let it be fufrkitnt to have pointed out thefe repetitions, which are fo
near one to another. However out of the more diftant ones, that I leave to
be enquir'd into by you, 1 cannot help taking notice of one, which, by rea-
fon of the ufual little arcs, and deceit of Blancardus, is not very eafily de-
tected. Read, I beleech you, the fixth article of the firft obfervation, and
compare what Formius has related of the fhoemaker, with thofe things
winch, in the third obfervation of the additamenta, Blancardus has faid of
the porter: and you will perceive that the hiiTory is the lame in both places j
but that the Choemaker of Formius was chang'd into a porter by Blancardus,
that the trick might not be found out. And if in writing to you I frequently
detect artifices of this kind, of which he has been guilty, I do it for this
rcafon, that you may withhold your affent, when you fhall read in the writ-
ings of an author, in other refpecls, learned, that Blancardus, indeed, " in
" his anatomic refcrmata, had been guilty of plagiarifm which was fcarcely
" excuiable . . . But that the anatomia praflica rationalise of the fame author,
M deferv'd a greater fhare of praife," that is to fay the very book, from
which thofe examples, that I produce to you here, are transfer'd into the
Sepulchretum.
2. And yet other hiflories were not wanting, which related to this fedtion, ,
whether they were to be taken from the Sepulchretum itfelf, or elfewhere.
For example's fake, our Saxonia (b) faw a fmith in this city " who after a
" long fupprefTion of flools, and great pains of the belly, partly by the life
" of acrid glyfters, and partly by the ufe of other remedies, difcharg'd ma-
" ny fmall ftones of the bignefs of a filbert, of a yellow colour, and fo ex-
" tremely hard, that they could fcarcely be broken by violence." And this
obfervation might have been very properly introdue'd in this fedtion, and it
would have been more particularly fuitable in that place, where (c) coftive-
nefs is dedue'd from calculi of the gall-bladder ; or if they fhould feem to
be too hard, and large, to be refer'd to that clafs •, although the biliary ca-
nals are fometimes found to be much dilated ; yet in this fedlion, at leafi (d),
a calculus, of the bignefs of a chefnut, which adher'd to the colon, is fup-
pos'd to be the caufe of a coftivenefs of the fame kind, or as a great number
of other obfervations which were already explain'd, pretty much at large, in
other fections, are repeated in this ; why is that wonderful hiftory (e) of the
maniacal man omitted here, who, though he devour'd every thing he met
with, neverthelefs fometimes difcharg'd nothing from his belly, which was
very tumid, for fifteen or fixtcen weeks together ? or not to digrefs far from
this fubject, as among the examples here produe'd of infants, who being
born without any aperture from the rectum, could of courfe dlfcharge no-
thing by that way, the obfervation of Floltzach (f), taken from one of tbem1^
(b) Prseleft. praft. p. 2. c. 19.
(c) Obf. iz. §• 2. 3. 7. 8.
fdJ.Obf. 9. §. 4.
(.') L. i.f. 9. in addic. cbf. 1.
(f) Obi". 11. %. 6,
who
96 Book III. Of Difeafcs of the Belly.
who difcharg'd the excrement of the bowels, by the penis, is repeated from
the next feclion (g) ; why is another fimilar one omitted, which had been
there produc'd (h)y from Hildanus, or two of Mcebius (i)t the firft of which
is very much like thofe, and the fecond relates to a little girl of fix months
old, who difcharg'd the abdominal fasces through the vagina ?
3. Of this laft kind is the obfervation of my fellow-citizen Mercurialis
(£), which is very much celebrated, if any other obfervation is, among the
medical writers Daniel Sennertus (I), Thomas Bartholin (m), Johannes
Rhodius C»), and others. But it is furprizing that Rhodius who refided
thirty-feven years at Padua, colle&ed his obfervations here, and publifh'd
them in the year 1657, did not enquire what had become of that fame
44 daughter of a Jew, who went under the name of a German" whoiu Mer-
curialis faw " in this city," and who, being born without any natural paf-
fage from the rectum, " difcharg'd her fasces by the vulva," and neverthe-
lefs, contrary to what might be expected by fome, " furviv'd."
However as Rhodius was not ignorant, from a fimilar, and equally cele-
brated obfervation of Benivenius (0), that another girl had not liv'd beyond
her fixteenth year, he would readily fuppofe that this Hebrew girl alfo, had
perhaps died the fame kind of death, not many years after Mercurialis had
ieen her, (and he had feen her before the year 1583), that is, had died from
an excruciating pain of the interlines, probably from the excrements being,
at that time, much indurated, and become fo thick, that they could not be
difcharg'd by a paffage which was not natural to them, nor yet perhaps pro-
per to convey emollient, and lubricating, clyfters commodioufly to the in-
teftines. But whether in the girl of Benivenius, this happen'd the more
eafily, becaufe me had no difcharge by (tool, more than once in eight days ;
or whether the Paduan Jewefs was more fortunate, Rhodius would certain-
ly have found, had he enquir'd, that fhe was alive even then, and had pafs'd
her leventieth year, (and not only, as a certain girl whofe hiftory is given
elfewhere f/>), of twenty years of age) : and indeed fhe even furviv'd Rho-
dius by many years, inafmuch as fhe, which is a very rare inftance even
among thofe that are mod healthy, liv'd a whole century, as was teftified to
me, by one who had fometimes attended this old woman, as a phyfician,
I mean Ifaac Cantarini, when in the year 17 19, he happen'd, as he was a
learned old man, to be talking with me of Mercurialis. But fhe always
bore up under her misfortune with patience, and without attempting to re-
lieve it, well-remembering the advice that was given to her father, by Mer-
curialis.
And there is no doubt but where another paffage is open'd by nature it-
felf, through which you may make a fufficient difcharge of the excremen-
titious matter, the inconvenience is to be prefer'd to the many and various
dangers, which, unlefs neceffity itfelf compels, are by no means to be enter'd
into, or at leaft not from the advice, and countenance, of a prudent man.
{g) Obf. 24. §. 1. O) Cent. 2. hid. 63.
(b) §. 2. («) Cent. 2. obf. 91.
(/') Obf. 22~ (0) De abdit. morbor. cauf. kc. C. 86.
(i) Demorb. puer. 1. 1. c. 9. (/) Eph. n. c. dec. 2. a. 10. obf. 75.
(/) Medic. pra&. 1. 4. p. 1. f. i, c. 1. in fin.
1 For
Letter XXXII. Article 3. 97
For nnlefs the aperture of the rectum at the anus, be found to be fhut up
only by a membrane, fo that by an eaiy and fafe incifion, an exit may be
given to the excrements, that are urging from above, as the diffection of a
little boy, defcrib'd by the celebrated Baverus (q), fhows might eafily have
been done, an incifion undertaken rafhly will frequently haften the death of
the infant, and will make that remedy infamous and horrible, which would
otherwiie be advantageous to many, it prudently made ufe of. For fuppofe
that the rectum has, in the whole extent of it, no paffage at all, but is folid
like a rope, as the eleventh obiervation, in this part of the Sepulchretum,
defcribes it (r) ; or fuppofe, to omit examples of other diforders, that the
whole of that inteftine is wanting, of which you will find an obfervation in
the fame place (s). Is not the fuccefs of the incifion, which you read there,
the fame with that which you read of in Schenck (()■> when in the daughter
of one Sichard an apothecaryr the furgeon attempted the diffection indeed,
but " did not find the rectum ?" As another furgeon did not, in like man-
ner, who perforated " to the length almoft of the little finger," in one of
thofe infants, I mean, whom Ruyfch found to be entirely without that intef-
tine («).
Nor indeed are inftances of this kind very rare ; for the celebrated Heifter
(x) has arfirm'd it to have been feen more than once by him alfo, and has
defcrib'd one example fully (y) : nor are we without another, befides thefe,
which you may read ellewhere, though taken notice of by the celebrated
Hoyer (2) only en paJJ'ant : and indeed that fometimes happens, likewife,
which may eafily deceive the operator, that is to fay, the lower part of the
rectum is not wanting : for by introducing the finger per anum, for fome
little fpace, which is fufficiently pervious, he naturally conceives a hope of a
fuccefsful incifion, as if nothing but a kind of membrane, which was inter-
pos'd, cut off the communication with the upper part of the rectum, and yet
this remaining part is in fact no-where •, but the other rectum is an inteftine,
which being full of feces, is inflected at a confiderable diftance from the
anus, to the upper part of the os facrum, and being fhut up, and firmly
concreted to that part, terminates there, as has been feen by the celebrated
Peter Chriftopher Wagner (a).
It is true, I fhould not always blame the furgeon, if an infant die on the
day after the incifion has been made, as that did whofe two little brothers
had, alfo, been born with an imperforated rectum {b). For although I have
read, that a great number of other infants, who were affected with the fame
preternatural diforder, have liv'd feven, ten, twelve, or more days ; yet I
have alfo read that fome, in other refpects healthy, and who had not under-
gone the leaft incifion, did not live more than three days.
However, unlefs it appear from diffection, that the chirurgical operation
has not been the caufe of death, he, in particular, will not efcape all fufpi-
(q) A&. eorund. t. 4. obf. 147. (x) Inft, chirurg. p. 2. f. 5. c. 163. n. 1.
(>) §. 4. (y) Eph. n. c cent. 3. & 4. obf. 193.
(s) §. 17. (z) Earund. cent. 6. obf. 59.
(t) Obf. medic. 1. 3. ubi de inteilino re&o {a) Commerc. Litter, a. 1735. Hebd. 46.
obf. 6. n. 4.
(») Adverf. anat. dec. 2. c. ic. (&) Eph. cit. dec. 3. a. 5. & 6. obf. 282.
Vol. II. O cion
9 8 Book III. Of Difeafes of the Belly.
cion of having haften'd the death of the infant, who, without properly con-
sidering every circumftance, has run headlong to the incifion, as if to a re-
medy that was not at all dangerous. Wherefore, when any other paiTage is
fufficiently open'd, although attended with great inconveniencies, and it is
not certain that the rectum comes down fo far betwixt the buttocks, that
its canal is cover'd only with the cutis, or a membrane of no great thicknefs;
we mull: not fearch, in that part, for what perhaps terminates in another
place, as for inftance, in the upper part of the vagina. For unlefs the inci-
fion penetrate thus far, it can have no effect in removing the complaint ;
and if it does really penetrate thus far, two other dangers remain behind,
be fide s that of haemorrhage, or convulfions, one of which is, left the paf-
fage open'd by nature, into the vagina, may never be quite clos'd up, not-
withftanding the incifion ; and the feconcl, left that which is open'd artifi-
cially by another way, mould from the want of a fphincter, to fhut up the
orifice, not remove, but double, the inconvenience.
4. But if there be no exit at all, to the abdominal fasces, a doubtful me-
thod of cure ought to be prefer'd to the certain death of the infant. For
nature has not dealt with other animals, as (he has with that infect, which is
call'd by the French Fourmi-iron, and which according to the obfervations
made upon infects, by that incomparable natural hiftorian Reaumur (<:), has
neither any anus, nor any inteftinal excrements that can be perceiv'd. And
if the cow at Perinthus, of whom Ariftotle (d) deliver'd down in writing,
what he had heard, had no external aperture to the rectum, " in which
" the excrementitious part of the food being attenuated, was difcharg'd
" through the bladder, and the anu being cut afunder, very foon clos'd
" up again, fo that the diforder could not be obviated by repeated incifion ;"
I have no doubt but I may fufpect, with fome probability, that the laft in-
terline terminated in the bladder; and the ufelefs incifions confirm -what I
juft now faid, of the difficulty either of penetrating fo far as there is occafion,
or of fhutting up a paiTage, which has been open'd by nature.
And I had the fame fufpicion formerly, when I heard that there was a
virgin at Bologna, who difcharg'd nothing by the inteftines, but all by the
bladder, difiblv'd in the urine. For that this inteftine has, more than once,
been inferted into the bladder, three obfervations, which you have join'd
together in the Sepulchretum, teftify (e), or at leaft two, if the third is the
fame as the firft, which this twelfth fection, being quoted in the former (/),
feems to fhow. But if none of thofe infants, that are defcrib'd in thefe ob-
fervations iurviv'c! •, the caufe of their death is, perhaps, to be afcrib'd, if
not lb much to the very narrow communication betwixt the rectum, and
bladder, fuch as is defcrib'd, and delineated, by the celebrated Sandenius
(£)> Yet at leaft to the narrownefs, length, and winding, of the male urethra,
which is, for thefe reafons, unequal to the talk of diicharging the urine for
a long time cogether, as it is now very thick, on account of the excrements
being mix'd with it (h).
(c) Memoir, pow. l'hift des inftft. t. 6. (f) Vid. obf. xi. §. 6.
mem. 10. (g) Eph. n. c. dec. 3. a. 9. & 10. obf. 19J.
(d) Deger erat. animal. 1. 4. c. 4. in fin. (hj Vid. tamen epilt. 65. n. 6.
(<?) L. 3. f. x.. obf. 24. §, 1. 2. 3.
Be
Letter XXXII. Article 5.
Be this as it will j as often as ever it a] that no is open for the
difcharge of the faeces, from the jntcftines, we mult not delay, till the long
retention thereof, begins to be verj injurious to the infant •, and, for thai
reafon, renders it lefs fit for the operation; but the cure mull ncceflarily be
attempted, having firft dechu'd to every one about the infant, the doubtful-
neis of the event ■, yet the attempt mull be always made with caution, and
with flail, left by one who is ignorant of anatomy, the bladder, or, in females,
the vagina, be wounded, together with the other parts, especially where the
inltiument mult, neceflarily, be introduced very high up.
For befides a very thick membrane, a fpongy rlelii, lometimes, and fat, to
the extent of two inches, may be interpos'd, as you will learn from the Se-
pulchretum (/'), and even lometimes, as you will read in the fame place (k),
the internal coalition goes up lb high, as to equal the length of " two joints
" of the little finger, of a moderately -fiz'd man •," and yet the child,
" having loll but little blood," in the perforation, and a proper cure having
fucceeded, was prelerv'd, fo that being at. length " an old woman," fhe
died, as it feems, of quite a different dileafe, which you will learn from
reading in another place (/), the conclufion of that obfervation, which is very
improperly omitted there. And you will find that another liv'd till it was
tour years of age, and is perhaps ftill living •, I mean one whom Hoyerus
(«.';, that I have commended above, cur'd by an incifion, longer than the
" joint of a man's thumb :" to take no notice of that, which the celebrated
Huberus («) mows it poffible to have fav'd, if the father of the infant had
iufrer'd the carnec-pingnedinous mafs which he faw in the dead body, and
which had been already cut through with the knife, in the living body,
" to the extent ofalmolt two fingers breadths," to be cut a little higher;
for by this means, the incifion would have reach'd into the cavity of the in-
teftine, that terminated clofe to it.
5. But, although this kind of diforder may fometimes be cur'd, even when
there feems fcarcely any hope of a cure, many of them are, neverthelefs,
abfolutely incurable, as when there is an occlulion, or adftriction, in fome
one of the higher inteftines, of which cafe you have inftances not only here
in the Sepulchretum, but will alfo have other inftances from me, at other
times. And to thefe you will add, not only the large fiefhy excrefcence, faid,
in the preceding letter (o), to have been found within the colon, by Cortefius,
but alio the fcirrhous ring, made up of glands, which the celebrated Haafius
(p), found in the fame place, and which left a foramen fcarcely fufrkient to
admit a {lender probe ; and, in like manner, the callus of the fame interline,
which was almoft cartilaginous, and which the celebrated Chriftian Wencker
(q) defcrib'd, from the obfervation of his brother, as rendering the tube, in
that part, extremely narrow ; nor muff that be omitted which is defcrib'd by
Laubius (r), of the colon, before it came near to the rectum, having its
Cjats fo contracted in a great part of thetube, as to render it not at allfurpriz-
{i) tpn. n. c. ace. I. a. 3. obi. 2
hn) Obf, 59. cit. fupra, ad. n. 3.
[n) Aft. n. c. t. 8. ob. 24.
(0 Obf. cit. xi. §. 14. (0) N. 21.
(4) Ibid, in fchol. ad §. 4. (/>) Commerc. litter, a. 1742. hebd. 45.
(!) Eph. n. c. dec. 1. a. 3. obf. 257. n. 2.
(?) DirT. fift. virgin, ventric. perforat. §. 5.
(r) Eph. n, c. cent. 7. obf. 41.
O 2 ing,
Book III. Of Difeafes of the Belly.
ruces could not defcend •, and ftill lefs muft we omit the fame
it is, at the fame time, extended to the greater part of the
frq^^O^^fe^h as was feen by Wahherus (.$), who was, when living, a very
c'd man. And not to quit the fubject of this laft inteftine, external
compreflion is often the caufe of an incurable coaptation therein.
Thus in the cafe given under the eleventh obfcrvation, of this fection of
the Sepulchretum (/), by whom could it be well-known, that a kind of
glandular tumour comprefs'd the upper part of the rectum, on both fides ;
and I may, with much greater propriety, perhaps, fay, by whom could it
be cur'd ? And I do not doubt, but the coalition of this inteftine is to be
deduc'd, rather from a tumour of that kind, than from " fome very hot
" medicines (#)," which had been taken, and which would dry up, and con-
tract, the inteftine, juft as fire is wont to dry up membranes ; provided,
however, that the coalition was really in the rectum, fince a portion of a
wax candle was introduc'd, as Donatus fays, " to' the length of a foot and a
" half;" for how this could happen in any man, I do not fee, unlefs the
candle was drawn away in an inflected (late, or unlefs the interlines were
differently difpos'd, from their ufual, and natural fituation. But let the co-
alition have been wherever you pleafe to fuppofe, that it is to be accounted
for, rather, from the caufe which I have mention'd, than from any different
caufe, another hiftory of the fame coalition, which is transfer'd hither from
Tulpius, will demonllrate (x).
For this author faw this inteftine, of which I am fpeaking, fo dcprefs'd by
two calculi of the urinary bladder, " that being ftreighten'd, and collaps'd, it
" produc'd many membranous filaments, which fo clofely interwove the in-
" ternal parietes of its tube, as to prevent a poffibility of its tranfmitting
" any excrement •," and in the fame manner, he had feen, at another time
(y)t " that fimilar filaments had obftructed the gula, which was ftreighten'd
" by a cancer." But this coalition of the rectum was incurable, alio, for
more reafons than one, as you will learn from reading that obfervation, in
the writings of Tulpius himfclf (2). Moreover, how much the inteftinum
rectum, when comprefs'd and made narrow, may obftruct the difcharge of
the f?eces, even without any connection of the parietes, you will learn from
other obfervations, which you may join to thofe of the Sepulchretum •, as,
for inftance, from that of Riedlinus (#), who found, in a man, that had died
of an obstruction of the bowels, " a mafs partly flefhy, and partly glandu-
" lar," which was larger than a fift, and comprefs'd the inteftine, near to the
urinary bladder -, and in the inteftine, alfo, were many " flefhy excrelcences :"
or from thofe of Jannellius, and Lancifi (£), who faw an obftinate, and in-
fuperable, coftivenefs in a matron, from the colon, and particularly, in its
lower part, being fo dilated, and heavy, as to force the uterus towards the
rectum, to confine it to a very narrow compafs, and caufe a great contrac-
tion of its canal: or finally, from that of the celebrated Hafeneft (c), who
(s) Diflert. <b intedinor. anguftia §. 20. (z) C. cit.
(/) §. 2. {a) Vid. aft. erudit. Lipf. m. jul. ubi ejus
(/<) Vid. fchol. fubjcft. curs med. rcferuntur.
(x) Obf. 14. §. q. (/>) Eph. n. c. cent. 10. in append, n. 4.
(y) Vid. ejus. obf. med. 1. 3. c. 1. in fin. (r; Commerc. Utter, a. 1740. hebd. 30. n. 1.
obferv'd.
Letter XXXII. Article 6. ior
obferv'd many ndipofe appendages, hanging, externally, to the fides of the
rectum, which, in their mape, refembled that or' a fmall pear, and which,
chough in confequence of their foftnefs they did not, indeed, bring on an
obflruction of the bowels, *' greatly prevented, neverthelefs, a free difcharge
from that canal.
6. There is, befides, .another diforder of the fame inteftinc, of which I
ice that no mention is made in this legion of the Sepulchretum. Ruyfch in
his Obfewatior.es Anatetnico-ckirurgh* (d)> and likewife in his Adverfaria (e) ;
dcicribes it under the name of " a fcirrhous thickening, and furprizing
eoarftation of the rectum," that is to fay, with its coats almoft exceeding the
thicknels of an inch, and fo much indurated, that he was in doubt, whether
to call them cartilaginous, or flefhy ; and with its cavity fo much diminifh'd,
in circumference, that a (lender probe could fcarcely be introdue'd fome-
times, nof could the feces be difcharg'd, without the mod violent ftrainino-s,
and that either in drops, or in a (lender fubftance, fcarcely thicker than a
(talk of grals. This diforder he afferts " to happen rarely, and for that
" reafon, to be known to few :" nor indeed does it appear, that it had been
feen by him, in more than two cafes •, fo that he put them in the number of
thofe, which he fuppos'd never to have been feen by Bidloo (/).
I remember that Valfalva was fent for to Faenza, to a very confiderable
man, who, as the fame fymptoms demonftrated, was troubled with the fame
difeale, or, at lead, with one. which was very near akin to it. I accompanied
Valfalva to that place, and he told me, that the fame kind of diforder had
been obferv'd by him, before, in others, and by diffedtion alfo, as I fuppofe ;
for I find no fuch thing in his diffections : but only in other papers, as far
as relates to two patients, whom he faw fome years after, .as the cafes, which
he has left in writing, together with the treatment of them, demonftrate. In,
both of them, he refers the difficulty in difcharging the faeces, from the in-
terlines, to the glands being become much thicken'd in the rectum, and in
part ulcerated ; and in one of them he fays that a tumour, in the form of a
ring, was perceiv'd to be prominent on the infide of the interline, about three
inches above the lower part of the rectum.
I myfelf was alfo confulted, in the preceding fummer, for a noble matron,
who having, for many months, difcharg'd the inteftinal excrements, com-
prefs'd into the fhape of a flat border, or fillet, and imagining that fhe was
troubled with no diforder, but that of the piles, had been lately found to
have the inteftine, about the upper part of the fphincter ani, fwell'd all
round, to the extent of two inches, and fo much ftreighten'd, that the point
of the finger could not be introdue'd, without force, and uneafinefs. As
this patient had, before, been fubject to tumours in the glands of the groins,
and the axillae, and likewife, to puftules, and ulcerations, and as, even at
this time, fome pus was difcharg'd before the feces, though not in great
quantity ; I readily judg'd that the fame thing, which Valfalva had perceiv'd
in thofe patients, by means of the finger, was to be perceiv'd, alfo, in this
matron, and wrote back this opinion, in my anfwer to thofe who confulted.
(d) Obf.95. & 96. (e) Dec. 2.c. 10. (f) Refponf. ad Bidl.
me.
102 Book III. Of the Difeafes of the Beliy.
me by letter, efpecially as I was led to the fame way of thinking, by fomc
oblervations of my own.
One of thefe which I ftill preferve, together with the di flection, I mall
the more readily write to you, becaufe I fee that this diforder, or at lead
one very fimilar to it, is defcrib'd, as far as it could be, by obfervations taken
from the living body, in the Commercium Litterarium (g), and clafs'd,
" with juftice, among thole that are more rare-," but I find no anatomical
in'pccYion of the patient, who died, fome time afterwards (&), of an iliac
paifion. And although I read, in another book (/'), that there was, in a little
boy, " fuch a difeafe of the rectum, as Ruyfch in the ninety-fifth, and ninety-
"• fixth, of his Obfcrvationes Anatomica, defcribes by a twofold example, that
" is to fay, a diforder in which the fphincter ani was concern'd, and by
" means of which, it had grown rigid all round, and contracted a very great
" fcirrhofity \* yet I obferve that the fame kind of diforder was common
to the other inteftines alio, and this in particular, " that the bowels in the
" beginning were a little coftive, but after fome time very lax ; and that the
" aliments, which had been but juft taken in, were, for the mod: part, dif-
" charg'd, without the patient's being fenfible of it." And for this reafon
I lubjoin my obfervation which is as follows.
7. A woman who was more than fifty years of age, had fallen three years
before from a hemorrhoidal affection, as fhe herfelf laid, into a much more
grievous diforder of the rectum, on account of which fhe was, at length, re-
cciv'd into the hofpital of incurables, at Bologna, about the end of the year
1 704. Valfalva having only afk'd queftions of this woman, without fo much
as introducing his finger, to examine the rectum, immediately pronoune'd
her diforder to be incurable, and, turning to me as I flood clofe to him, laid,
this is a diforder of a fimilar kind with that which I found at Faenza, fome
months ago, when you were there with me (£), that is to fay, a glandular
tumour occupies the circumference of the rectum here alfo. And this wo-
man, although with the other fymptoms of this diforder, fhe perceiv'd no
pain, difcharg'd, neverthelefs, a great quantity of foetid matter, fometimes
thin, and at other times pretty thick. Wherefore, being brought to the lafl
ftage of a confumption, fhe died within a month, or two, from her coming
into the hofpital, after fevers which attack' d her with a chilnefs.
The in teftinu m rectum being laid open longitudinally, and difplay'd, I examin'd
it, and found it in the following ftate. At fix or feven fingers breadths above
the anus it began to become pretty hard, and thick, and to fwellout, every
where, from the furface, internally, into bodies, which, in their figure, and
fize, refembled very large beans. They were all fmooth in their furfaces,
but of a folid and compact fubflance. The hardnefs and thicknefs of the
inteftine, and the bulk of thofe bodies, which were more nearly fimilar
to conglobate glands, than to any other bodies, and in their colour alfo,
.as well as in their fize, and figure, were proportionably increas'd, as you
came nearer to the lower part of the canal. Yet the lower part of the intef-
tine, as far as it could be cover' d with the breadth of a finger, was found,
[g) "A. 1-+2. Kebd. 35. §. 3. n. i. (/) Act n. c. torn. 2. nbf. 65.
(b) A. 174.4.. heb. 2. §. 3. n. 2. (/(•) Vid. n, proximo fuperioie.
2 and
Letter XXXIL Article 8. 103
and from the very extremity of the anus bung two cxcrefcenccs, at the fame
time that the cutis was (lightly ulcerated about the anus.
8. Now in order to perceive that Valfalva's obfervations, and mine, differ
lefs from thofe of Ruyfch, than, perhaps, appears at firft fight, compare
them together, and you will find that the fir it patient of Ruyfch, alio, had
excreted (I) the inteiVnul fxces, with " a*n ichorous, and purulent matter,*1
and that the difeafe of the fecond (m), was, by Ibme phyficians, thought
" to be the piles :" both of which happen'd likewife in moit of our patient-;.
And indeed I believe that one principal reafon, amongft others, why this dif-
order, though, perhaps, not very rare, has been known to very few •, nor has
been found out, for the mod part, till very late in the difeafe, when the
finger was at length introduced, is that the patients, and the phyficians, ge-
nerally fuppofe no difeafe to be concern'd in the cafe, but the piles. And
for this reafon, in that fecond cafe of Ruyfch's it was refolv'd, that they
ihould be taken away by incifion, which was even attempted, but of courier
without effect. And, indeed, even if that kind of diforder which I have de-
fcrib'd, were of fuch a nature, that it could be remov'd by the chirurgical
knife ; yet the very feat of the difeafe, as it has been feen by Ruyfch, and
by us, is often fo very high up within the inteftine as to leave no room to
admit of fuch a method of cure.
However, that ancient opinion, which is circulated together with the
books of Hippocrates (;?), does by no means efcape me •, I mean, that " the
** inteftinum rectum may be cut, and repeatedly cut, may be few'd up, may
M be burnt with actual, or potential cauteries, and may be flough'd away
" afterwards, and yet, notwithstanding thefe things may feem fo very vio-
*c lent, they will have no mifchievous confequences." But, at the fame
time, neither does it efcape me, that this dogma is, by the mod fkilful fur-
geons, generally refer'd to that part of the inteftine, from the more deep
incifion of which moft of the ancient furgeons abftain'd, left they mould cut
afunder the fphincter ani, and take away its power, and office, for ever. And
if this fear had not been, in great meafure, remov'd, by the obfervations of
others, I could have affur'd you of my having heard Valfalva fay that he, by
making the experiment upon dogs, had found this fphincter, when cut
afunder through the whole of its thick nefs, to have again recover'd its
power, and perform'd its office, though not fo ftrongly as before, and that
he had obferv'd the lame thing, in the human body, on fome occaiions.
I have alfo read, in a certain paper of his, which was written after this
time, that a man had been cur'd by him, in the year 170S, in whom an ab-
fcefs, and a gangrene, that fucceeded thereto, had eroded part of one buttock,
together with that whole portion of the fphincter, which correfponded to it,
fo that the faeces were difcharg'd involuntarily : that this man, though in
coniequence of thefe diforders, he was brought to the very threfhold of death,
had efcap'd, and his ulcer being perfectly heal'd up, that the fphincter had
return'd to its former (late. But, notwithstanding the truth of thefe things,
the farther you go up, above the fphincter, fo much the more dangerous
the incifion will be, whether, fome larger blood-veifel being hurt thereby,
(/) Obf. ibid. cit. 95. (w) Obf. 96. (n) L. dc Hemorrhoid, n. 1.
you
104 Book HI. Of Difeafes of the Belly.
you may not be able to flop the flux of the blood'; or fome nerve, being
prick'd, give rife to that mortal pain, which our Fabricius has obferv'd (0),
and which feems to have proceeded from this caufe •, or, finally, whether,
neither the artery, nor nerve being wounded, you only perforate the inteftine,
and by this means open an exit for the feces into the cavity of the belly :
for who is able to avoid thefe dangers, in blind and dark incifions ?
9. For thefe, and for other reafons, therefore, which are of themfelves
fufficiently manifefl, when there is not room to attempt an efficacious cure,
it remains that witli Ruyfch (p), and Valfalva, we neceflarily embrace that
which is call'd palliative. The firfl commended emollients, and glyfters, that
alleviate pain. Nor did the other dilapprove of them, unlefs they flow'd back
immediately : for which reafon, he rather recommended the injections of
fmall quantities, and frequently, and even to bury in the rectum, as far as
the patient could bear it, without uneafinefs, the tube through which thefe
clyflers were convey'd, and which fhould be properly perforated, laterally,
lb as to fuffer the fluid, that it convey'd, to come to the very feat of the dis-
order : he alfo, on the fame plan, advis'd to ufe a bath of an emollient, and
lenient nature, and to keep a pipe of this kind in the rectum, while the pa-
tient fat over the bath, fo as to admit the fluid into immediate contact with
the difeas'd parts.
However, the fluid that he recommended, to be us'd for this purpofe, was
different according to the different flate of the difeafe ; fometimes he us'd
lime water more or lefs diluted ; fometimes the water of that warm bath,
which is above Bologna, and which he fometimes alfo gave for drink ; and,
at other times, when he fuppos'd there to be no ulceration join'd to the other
diforders, he medicated common water, by boiling in it fuch ingredients, as
he thought would be of mofl fervice.
So he alio prefcrib'd various remedies to be taken internally, and among
thofe the turpentine- refin, after which was to be drunk a water, medicated
with vulnerary herbs, (with which he fometimes mix'd this refin diflblv'd in
the yolk of an egg, and us'd it for injections) ; but, fometimes, when the
feafon of the year was very warm, he omitted the refin, and made ufe of
water, in which the fame, or other herbs, had been occasionally boiled, but
in fmall quantity only, in proportion to the water •, fo that a very free ufe
might be made of it, almoft like the warm bath waters ; and he would
even have it drunk by way of common liquor : but in the winter he recom-
mended wine at the table, and that of the domeftic kind, in which, at the
autumnal feafon, when it fermented in the cafk, fuch roots, woods, and
leaves, as he thought to be mofl fuitable, had been macerated.
Hitherto I have follow'd the advice and example of both thefe gentlemen,
in fuch a manner as to recommend fome of thefe remedies, in preference to
others, and, in general, to mix with them fuch medicines, as are effectual
againfl the venereal difeafe, inafmuch as I have obferv'd that a diforder, of
the venereal kind, has been generally accuflom'd to precede the diforder of
which I treat ; and ftill lefs did I omit fuch things as I have known to be,
fometimes, of great fervice, in difiblving hard tumours. For I believe that
(<?) De chirurg. oper. c. de an fiftul. in iin, ,(p) Obf. cit. 96. in fin.
thefe
Letter XXXII. Article 10. 105
thefe ought to be us'cl more frequently than thole which are properly emol-
lient, left it lhould happen, that the fibres being too much relax'd, the parts
yield to the matter that falls upon them, anil .the tumour being, by this
means, increas'd, all paffage lor the excrements is intercepted : and, in like
manner, we are to endeavour that thefe may be loft, left, being hard, and
large in their dimenfions, they ferve as an obftruction to their own exit,
through a paffage, which is already too narrow, or left, if they do pafs through,
they lhould caufe, by their violent comprefiion upon the tumour, pains, and
ulcers, or if there are any already, increalc them-, yet we muft not, for thefe
very reafons, ufe fuch medicines, in order to bring this about, as are either
in themfelves acrid, or may iblicit a quantity of acrid humours towards that
part.
10. There are two diforders, which are the confequences of that coflivenefs,
upon which I have written to you thisfhort letter, the one more frequenrlv,
which is the dilbrder of the hemorrhoidal veffels, commonly call'd piles,
and the other not very rarely, I mean the prolapfus ani. In regard to the
latter, as you knew there was no fection in the Sepulchretum, on that fub-
ject, it is for this reafon, I fuppofe, that you have, lb long fince, earneftly
entreated me to communicate to you, a long opinion which you had heard
was written by me, and this, fuch as it is, I will fend you in the next letter
upon the hemorrhoidal affection, however, there is a fection in the Sepulchre-
tum (f)-, but fo fhort is it that, if you take away the fcholia, it fcarcely tills
up half a page. For which reafon I choofe to add fome things here, upon
the fubject of the piles, rather than, when 1 come to that faction, write a
whole letter upon it, cfpecially as among the obfervations of Valfalva, or
among mine, we fcarcely find any directions, which properly relate to thefe
difeales. Therefore, as to coftivenefs of the bowels, frequently bring-
ing on the piles, as I laid juft now, it is not to be doubted, and it is thus
explain'd- by Boerhaave (r), that in the ftraining neceffary to difcharge the
faeces, " the inteftines are comprefs'd, the arterial blood is circulated more
*' brifkly, the venous is retarded, and even ftagnating in the veffels of the
" inteftinum rectum, putrifies, and by this means brings on a difpofition to
" the piles."
I am not ignorant, however, that the blood ftagnates in the veins of the
fame inteftine, from other caufes alio. For as the moil internal of thefe veins,
finally terminate in the trunk of the vena portarum ; if it fhould happen that
thefe veins, either in their paffage, or in their termination, or even in this
part, fhould be, for a confiderable time, ftreightened, or prefs'd, by the con-
vulfion, diftention, or obftruction, of the furrounding parts ; it is natural to
fuppofe that the blood would, certainly, be too long detain'd in thefe veins :
fo if the mefentery be convuls'd, or if the inteftines are too much diftended
with, flatus, or if the liver be obftructed, the fame thing may eafily happen.
And of this kind is the obfervation of Vefalius, which is the firft, and at the
lame time the principal, of thole three that you read in the very fhort fec-
tion, which I juft now pointed out.
(q) L. hujus 3, feet, 15. (;•) Praeleft. in init. §. 774. in iin.
Vol. II. P For
106 Book III. Of Difeafes of the Belly.
For in him who had labour'd, at intervals, under a flux of blood, from
the hemorrhoidal veffels, the fpleen was not the only vifcus indurated, as
you will perhaps fuppofe, from turning to the fifth chapter of the third
book, Be Fabrica Corporis Humam, from which, alone, that obfervation is
copied in the Sepulchretum •, but " the liver was furprizingly hard " alio, as
you will learn from the fifteenth chapter of the fifth book, where Vefalius
gives the fame cafe a little more at large, and, at the fame time, you will
underftand, or at leafl in part, the real caufe why the internal hemorrhoidal
vein " was equal nearly to the thicknefs of a man's thumb, at the extremity
" of the colon, and through the whole length of the rectum ■" which in his
time he could not underftand.
Without doubt, it was not very eafy for the blood to pafs through a liver
of that kind. But why then, you will fay, did it not ftagnate, equally, in
the other veins, which go to the trunk of the vena portarum ? And for this
very rcafon it was, that I faid you would immediately underftand it, or at
leaft in part. Add therefore, to omit other things, the very great length,
which is peculiar to this one vein among the others, fo that it is much more
difficult for the blood to be carry'd upwards, from this vein, than from the
others, efpecially as the fituation of the human body requires it, which, with-
out doubt, is one of the reafons, why other animals are not fubjedt to the
piles. And if you aik why, in thofe bodies, in which there is any impedi-
ment to the quick motion of the blood upwards, the veins of the legs in par-
ticular are dilated into varices, you will find the fame thing to be the caufe,
of them chiefly, which we affign for the piles.
You fee, even in the Sepulchretum (j), that Waleus exprefsly afierts the
piles " to be nothing elie but varices of the veins of the anus." And you
will find Boerhaave confirming this opinion, in another place (/), where he
has declar'd the fame things which I copied from him juft now, but more at
large, and without the leaft mention of putrefaction. And how much thefe
veins may be dilated, I obferv'd in a certain man («) of a good habit of body,
but inclin'd to be plethoric, who died at Bologna, in the year 1706, of a
wound under the axilla, and whole body I difiected. The extremity of the
intcftine, in this man, appear'd to have been fubject to the piles, as it was
internally unequal with varicous knots of veins ; and as I look'd upon the
largeft of 'thefe veins very attentively, I wonder'd that none but the fmalleft
blood-veflels communicated with it, though itfelf was diftended with a large
quantity of grumous blood ; fo as to make it evident, that fome very fmall
vein had been expanded, into fo confiderable a fize.
11. That thefe things therefore, may not happen, which it is well known
do by no means happen, without fevere pains •, and efpecially at the time of
going to ftool, if thefe varices are really turgid, and not yet ruptur'd : or if
they are ruptur'd, not without a hemorrhage fucceeding, which is fometimes
immoderate, and leaves fuch confequences behind it fometimes, as have more
than fufficiently fliown us, that the piles are not greatly to be defir'd-, in the
firft place a plenitude is to be avoided j for in men there are not pafiages pre-
{s) In fchol. ad 1. obf. feft. cit. («) Dfihocvid. epift. 44. n. 22.
(.') Pnelett. cit. ad §. 117,
parM
Letter XXXII. Article 12. 107
par'd by nature, for the fuperfluous blood to be conveniently thrown ofl', as
there are in women, in whom it was necefiTary •, but they mult be open'd
by difeafe, which is then fometimes falutary, but often dangerous, and al-
ways inconvenient.
In the lecond place fuch things ought to be avoided, as render the belly
very coftive •, and I do not only mean to avoid taking in a great quantity of
ftvptic, and aftringent juices, which by criiping up the minute orifices of the
glands, that moiiten the interlines, and their contents, do not fuffer a fufri-
cient quantity of moifture to be difcharg'd •, but I lpeak even of the cuftom
of eating, and efpecially of drinking, much more fparingly, than nature can
bear. Thus we read in the life of Sarpi, that as he, when a young man, ate
very fparingly, and drank nothing, even for many days, he fell into an ob-
ftinate coftivenefs, in confequence of which, he not only went to ilool no
more than once in three days generally, but fometimes only once in feven,
and, in order to do that, was oblig'd to ufe fuch violent (trainings, that
brought upon him great pains from the piles, and a troublefome prolapfus*
ani, under which he labour'd for many years.
But if, notwithstanding thole things, that I have caution'd you againft,
being avoided, and others of the fame kind, the inteftinal fasces (till continue
to be very hard, and the more frequent ufe of emollient food, is not of ad-
vantage againft this coftivenefs ; there is, perhaps, no remedy to be prefer'd,
for preventing the piles being the confequence of thefe (trainings, to that
which I fee is us'd by phylicians of note, in order to prevent their being fo
painful, at the time of going to ftool, when they are already form'd in the
inteftine. They inject, before the time of going to ftool, an ounce of any
emollient oil, and, in particular, linfeed oil : which I have alfo been accul-
tom'd to ufe frequently, and fuccefsfully, (when the hard excrements are to
be ibften'd, and the lower part of the inteftine to be lubricated) nearly in
the fame quantity, or at leaft not in a much greater, left it immediately flow
back, and even that it may be for along time retain'd : although I have,
fometimes prefcrib'd olive oil in this manner, from the very time in which
Ramazzini inform'd me, that in the cafe of a woman in child-bed, who, for
feven days together, had never gone to ftool, after a great number of diffe-
rent things had been tried in vain, it came into his mind, which he faid, if
I remember rightly, he had read in Martinus Rulandus, that two ounces of
common oil fhould be injected every hour, and that by this means he had
procur'd a difcharge.
12. The mention of this remedy brings to my mind another, which I have
heard was applied by an il'uftrious womjn, who had been troubled, for a
long time, with a tumefaction of the haemorrhoidal veffels. As (lie came
hither for the fake of confulting me, after I had examin'd them, I afk'd her,
by what means (he was able to put them up again as they were fo fwelled,
without almoft intolerable pain ; (he immediately anfwer'd, that fhe, after
having made trial of a great number of things, had found nothing more ufe-
ful, than the fat that lies about the kidnies of a dog, which has yellow,
or rediih hair. That with this fat, properly prepar'd for the purpole, (lie
anointed the piles when they were pufli'd down, at the time of going to (tool j
and, by this means, had been us'd to pufh them up, for a long time, with-
P 2 out
to 8 Book IN. Of Difeafes of the Belly.
out pain, or at leaft with much lefs pain than fhe otherwife could, from the
very time that others, having made the experiment, communicated it to her
as a fee ret.
Indeed I had before known that phyficians, fometimes, made ufe of the
fat of a dog, and not only the external, but the internal fat, yet the ufe of it
for this particular purpoie, and of that which is taken from a particular part
of a particular dog, I do not remember ever to have heard of, or feen. It
is much more eafy to aflign a caufe for the utility of the two methods that I
(hall relate to you •, for they are much more in common ufe, although not
made ufe of, or at leaft in general, 'againft the fame difeafe, nor in the fame
manner. That is to fay, I law Albertini alleviate the violent pain of the tu-
mid haemorrhoids, in a certain nobleman, by applying to them the internal
parts of gourds, or by injecting water in which thefe had been boil'd : and
from another nobleman of the firft rank, and character, who had lately held
the office of vice-roy, when he came to me, to afk medical advice for his
children, I heard, on occafion of the piles being mention'd, that flannels
fteep'd in warm water, in which linfeed, and the flie'd roots of marlh-
mallows, had, for a confiderable time, been boil'd, being now and then
applied to the parts, he had lo far found advantage by them in this diforder,
that they not only alleviated the pains, but if they were applied, immediately
upon the beginning of them, did not fufferthe hemorrhoidal tumour to in-
creafe, and, confequently, did not fuffer the piles to burft, and caufe a con-
fiderable lofs of blood.
But where this haemorrhage was in too great a quantity, Valfalva, to re-
turn to the phyficians, commended three things, in preference to others,
from which it had happen'd that he had feen furprizing effects : the firft,
to anoint the umbilical region with frefh theriaca, in which opium has
been mix'd in the proportion of four, or even of fix grains, if the flux is
confiderable, to about fix drams. The fecond was to apply vitriol redue'd
into a calx, which is caird by chymifts colcothar, to the part from whence
the blood flows. The third, to take care that the patient fhould prefs the
lower part of the inreftine downwards, if perchance, as fometimes happens,
the open foramen of the fanguiferous vefiel may be brought into view: and
then to apply a little piece of vitriol, fitted in the orifice of a pipe, as pain-
ters are wont to apply the haematites, to this foramen, and to continue it
there for a little time, till it bring on a cruft. And in this order, in which
he propos'd them, he would have them be applied, one after another, that
is to fay, where the former had not anfwer'd their end.
13. And becaufe the queftion is not here of new remedies, or of unufual
methods of cure, but of thofe which, from the teftimony of illuftrious pa-
tients themfelves, or that of grave phyficians, have been found ufeful,
and, in particular, of the method us'd by our Valfalva; I will alio add this,,
as you defire to know it. If he happen'd to light on a patient, who was
not very defirous to undergo any chirurgical operation, in order to prevent
his being fubject to an immoderate flux of blood, from the hemorrhoidal
veins, in the future, it was not his cuftom to follow, unlefs perhaps in a re-
cent dilbyder, and indeed by another method of cure, I fay, it was not his cuf-
5 torn
Letter XXXII. Article 13. 109
torn to follow the author of that little book, entitled (x), de hamorrhcidibus,
which teaches us, " that we ought to leave no hemorrhoid, or pile, un-
M burnt, but to deftroy them all by burning •" he rather followM the author
of the fixth Section of the aphorifms, who admonifhes (y) " that if, in a per-
41 fon who is cur'd of piles, that have been of long (landing, one of them is
M not preferv'd, there is danger that an anafarcous dropfy, or a coniump-
" tion, may come on." ' For this he took great care of, even in curing ul-
cers of the anus. Thus, once when he Ihow'd me a certain perfon who had
labour'd, for fixteen years together, under thefe ulcers, and who was, even
then, extremely well, though it was in the eighth year after his cure-, one
ulcer, laid he, which was kls troublelbme than the reft, I purpofely left un-
touch'd.
And I remember, when it was a matter of controverfy whether the dis-
orders, with which two knights, of diftinguifh'd rank, were troubled, were
piles, or ulcers, that he immediately fhow'd them to be ulcers, in both of
them. For in one of them, having introduced his finger, pretty high up
in the rectum, he pointed out to the others, the certain Situation oi the ul-
cer, as the apex of his finger being receiv'd into the orifice of it, feem'd to
be embrae'd around, with a kind of ring as it were ^ for in this manner he
aflur*d them, that the ulcers of the rectum, or vagina, were frequently
found, fo that a narrow mouth is dilated into a more capacious finus. And
in the fecond, without introducing his finger, he not only fhow'd that there
was an ulcer, but alio that it was not very high up •, for there were lb me,
among the others, whofuppos'd that what was excreted, was a mucus prefs'd
out from the glands of the rectum, which are pretty high up in the inteftine.
But thefe he eafily convine'd, even by the teftimony of the patient himfelf ;
for as he confefs'd that this matter flow'd from him continually, it follow'd of
courfe that the original fprings of it could not be above the fphincter. And
as this matter, even in the opinion of Valfalva himfelf, whofe judgment, in;
an affair of that kind, was known to be peculiarly excellent, was without
any hefitation pronoune'd, and even demonftrated, to be purulent, there
now remain'd no doubt at all, but it was to be accounted for from an ulcer.
And they fo much the more efteem'd his judgment, in this cafe, as it was
well known to every one, that he was extremely clear, in regard to thofe
things which are alio taken notice of, in the fcholia to that firft obfervation
(2) of the fifteenth Section, of certain mucous, and whitifh fordes, Sometimes
proceeding from the anus, which, although they have impos'd upon fome,
and been taken for pus, yet are known, by the mod learned phyficians,
to be excreted from the hemorrhoidal veins, juft as a fluor albus (which
was the comparifon of Platerus, who is quoted in the fame fcholia) is often
Secreted from the vefTels of the uterus, without any fufpicion of an ulcer.
And this will be eafily explained by you, in the fame manner that you See,
an uterine fluor, oSthis kind, explain'd by me, in the fourth of the Adver-
faria (a), that is to fay, if you conceive that the apertures of the veflels, which,
when in a more dilated Hate, pour'd out red blood, being now more con-
(■*) N. 1. (%) Supra, ad n. 10.
(j) Aphor. 12. \a) Animad. 27.
£ringsd,
no Book III. Of Difeafes of the Belly.
ftring'd, though not altogether, do not fuffer the red part of the blood to
efcape any longer, but only the ferum of it, which is, of itfelf, vifcid in fome
perfons, or becomes mucous by ftagnation, and that this diftilfs gradually,
or partes downwards, when prefs'd out by the excrements. And thus far I
had to add on the fubject of the piles.
LETTER the THIRTY-THIRD
Treats of the Prolapfus of the Inteflinum Rectum*.
THERE is not only no fection in the Sepulchretum Anatomicum, upon
the prolapfus of the inteftinum rectum •, but even no anatomical ob-
fervations are extant any where, as far as I remember at prefent, which relate
thereto. And fince upon thefe, as upon a firm bafis, all the folid reafonings
of phyficians, about the internal origins of difeafes, or their continued
caufes, are generally founded •, it is for this reafon not to be wonder'd at
that no treatife has ever yet been publihYd upon this difeafe (for no fuch
treatife has fallen into my hands at leaft, though treatifes have been pub-
lifh'd upon more rare, and much (lighter diforders) which might ferve as a
guide to any one, whofe bufinefs it was to write upon this fubjecl, and
lefTen his labour •, for this fubjec~t ought not to be handled in a hafty, and
confus'd manner.
I never found myfelf more in want of a treatife of this kind, than when
I was afk'd to give the opinion which I have promis'd, in confequence of
your long-continued entreaties, to fend you a copy of in this letter. And I
fend it to you juft as I then wrote it, its tranflation from the Italian language
excepted. And I know very well, that the difcourfes upon difeafes, which
are requir'd by way of opinion, either almoft immediately, or, within a very
few days, by the friends of the patients, can have, when drawn up by me,
no merit but that of difpatch. For which reafon I give copies of them to
none, but to thole for whom they are intended : and from thefe perfons,
muft have come thofe copies of opinions of mine, which you tell me you have
read in great number •, unlefs fome have been fallly and furreptitiouily taken,
by thofe whom I employ'd as copifts, as I fee has fometimes happen'd.
But, although this which you will have at prefent, is not very much ap-
prov'd of by me, and though I had rather have fent any other •, yet if it
will not ferve to fhew, how to diftinguifh thofe opinions which are really
mine, it will, at leaft, fhow you the greater part of thofe things, which I
would wifh to have enquir'd into, by anatomilts, in relation to this difeafe.
For this purpofe then, it was written, and in the following manner.
2. I wifh
Letter XXXIII. Article 2, 3, 4. m
2. I wifli the internal caufes, by which the diforder of this noble, and
very learned, man was iirft brought on, and by which it is ftill prefer* 'd, were
as evident as the difeafe itfclf, and the cauie which incrcas'd it ; and, what is of
ftill greater importance, I wifh that the moft effectual fhethods of remedying
this difeafe, were as well afcertain'd as the difeafe itfelf.
The difeafe of which I fpeak is a prolapfus of the inteflinum reclum : and
the cauie by which it was -increas'd, was a violent and long-continu'd (train-
ing at the times of going to itool. But in what manner it was increas'd, by
theie (trainings, from whence it had irs beginning, and what its beginning
was, and by what caufes it is ftill preferv'd, or, as the language of phyficians
is, continu'd ; all theie circumftances, efpecially at fo great a diftance of
times, and of places, it is very difficult for me to fubjoin, and to know al-
moft impoflible. But if there were any one who had been able to obferve
the fymptoms, and crifes, of that obftinate, and troublefome fever, to which,
the beginning of this diforder fucceeded •, and to confider, accurately, at that
time, and when it was afterwards increas'd, and at this time alfo, of whac
nature the upper, and lower, extremities of the tube, which came forth,
were, and what was its confifience \ it would perhaps have been lefs difficult
for him to conjecture the true caufes of the diforder.
3. Thefe caufes, if they are even only confider'd jointly, may be many,,
and very different from each other. That very learned fellow-citizen of mine,
Hieronimus Mercurialis (a), and Ambrofe Parey (£), affign one caufe in par-
ticular, I mean the relaxation of the fphincter ani, which fuffer'd the inteftine
to come forth. But medical experience does not eafily fuffer me to afTent
thereto, as thereby I am taught, that a prolapfus of the inteftine does notr
immediately, fucceed to a true paralyfis of that fphincter, but only after
fome time has been interpos'd : and in our patient, in particular, I underftand,
how ftrong this mufcle ftill is, fo that it refifts every other even violent motion.
But Joannes Riolanus (c) ; I mean the father ; adds to the relaxation of the
fphincter, that of the relaxation of the levatores ani alfo: and this the greater
part of phyficians admit. However, that this was the cafe in the prefent in-
ftance, and had been fo from the beginning, I would neither boldly deny,
nor for a certainty affirm. I only fay this, that if it was fo, it certainly was
not the only caufe, after the difeafe had continu'd fome little time. For I
know from anatomy, that the part of the inteftine, which can remain with-
out the anus, from this caufe alone, that it is not rais'd by thefe mufcles, is
the lower part, and only of the extent of a few inches ; and that the part
which lies above this cannot hang out for that reafon, to the extent of eight
or ten inches in length, and even to fixteen or twenty, if it be confider'd,
that, by being inverted outwards, it muft be in a double ftate.
4. It becomes neceflary therefore, to look out for other caufes, and in
particular that, amongft others, which was hinted at, by the learned phyfi-
cian who confuked me ; I mean the feparation of the inteftine from the me-
focolon, or fome other caufe, which amounts to the fame thing, and which
happens more eafily ; as for inftance, a relaxation, gradually brought on, of
(a) De morb. puer. 1. i.e. 10.
(6) Oper. chirurg. ]. 7. c. 18..
(c) Meth. mcd. fe&. 3. ubi de IleofL
the
1 1 2 Book III. Of Difeafes of the Belly.
the latter part of that mefocolon, which ferves as a ligament to the rectum,
and to that neareft, winding, and moveable, trad: of the colon, into which the
rectum terminates.
It does not efcape me, that, to fome very modern profeffors of medicine,
it does not feem probable, that the whole body of the inteftine fhould come
forth, confidering the firmnefs of its ligaments, and its cloie attachment to
the vagina uteri in women, and to the neck of the bladder, and the neiorh-
bouring parts, in men, and confidering an obfervation, bcfides, which they
quote from Cowper (d)y of a man, who, after a long continu'd prolapfus
ani, and, at length, a iphacelus of the prolaps'd inteftine, from too great
intemperance, although he had undergone an extirpation of the corrupt parts,
which hung down, not only recover'd his former health, but even liv'd quite
free from the prolapfus. They, therefore, and the celebrated Junckerus(^),
believe that the whole body of the inteftine is not relax'd, but only the in-
ternal part, and that this, being thicken'd, is inverted, and pufh'd out: and
I would not deny, but that which is fuppos'd to happen in the prolapfus of
the uterus, or, rather, in the more frequent prolapfus of the vagina, that
many improperly confound with the prolapfus of the uterus itfelf, which is
indeed very rare, is favourable to their opinion.
But, although I am not unappriz'd, how much membranes, that are
drench'd, as it were, with moifture, may be relax'd, thicken'd, and made
long, yet when I read over what our Fabricius ab Aquapendente (f) afferts
his having feen in fome perfons, that is to fay, " a procidentia ani fo long, as
" to be equal to the length of the fore-arm, and fo thick, as to be equal
to both the arms join'd together" (which paffage, perhaps, had efcap'd Junc-
kerus (g), when he judg'd that a prolapfus, mention'd by Muralt (£), of an
equal length, " aim oft exceeded all belief")-, when I read, therefore, fuch
things, I feem inclin'd to believe, in fome certain cafes, with the celebrated
Polycarp Schacher (/'), that the thing happens neither in that firft, nor in the
fecond manner, but rather in the third which is propos'd by him.
That is to fay, the lower part of the inteftinum rectum, which I have
faid to be firmly connected with the neighbouring parts, being unmov'd, the
other part, which is fuperior to this, falls within it, together with the fasces,
and being inverted, comes forth on the outfide of the anus. For it is fuffi-
cient that the mefocolon is there relax'd, where it confines the rectum ; or
if the prolapfus is very long, that it is relax'd in that place befides, where
it belongs to the neighbouring moveable, and winding tract of the co-
lon, which being, in fome perfons longer, and in others fhorter, as I have
faid in the third of the Adverfaria (k), fo it may be more or lefs extended,
and defcend, and fufTer the rectum to be prolaps'd. But if this additamen-
tum of mine were not fufficient, I fhould then, moreover, think of another,
-as if befides thofe three methods mention'd above, a fourth might be pro-
pos'd, according to which, what I juft now fpofce of, in the third, might
happen, and the internal coat befides, as was faid in the lecond, being re-
\
{d) Anat. of hum. bod. 60 1, t. 39. f. 7. (h) Eph. n. c. dec. z. a. I. obf. 113. in
(i) Confp. med. tab. no. fchol.
(f) De chir. oper. c. de ani procid. (/') Difp. de morb. afitu intcft. p. n.c. 2. §.3.
(b) Tab. cit. U) Animad. 6.
lax'd
Letter XXXIII. Article 5, 6. 113
Ux*d, inverted, and falling down, might come forth through the lower ex-
tremity of the prolaps'd inteftine, unci increafc the length thereof, by being
added to it.
5. It is not my cullom, indeed, to ufe very long harangues in the theo-
retical part of medical opinions, for I am not ignorant that moll: patients are
like the empirics, who do not doubt, as Celfus fays (/), " that thefe conjec-
" tures, upon occult caules, are very little to the purpofe, becaufe it is of
" no importance what has produe'd the difeafe, but what will remove it."
Yet in this cafe I thought proper to proceed differently, not only becaufe
the patient, who requires this opinion of me, is very learned, but alio be-
caufe, notwithstanding fome animadverfions, which I may deduce from thofe
things that I have hitherto laid, would not perhaps {how the utility of what
I have advane'd, contrary to the opinion of the empirics (without doubt as
the prolapfus of which I fpeak, may be join'd with one, or with Janother, or
with many of the caufes that I have hinted at, and as it. is not in my power,
for the reafons I gave in the beginning (m\ without the greateft difficulty,
and confequently without very great danger of erring, to determine with
which it really is join'd) it is neceffary, at lead, to gather by a kind of in-
duction, which is what I am at prefent doing, that it is always probable, whe-
ther there be, in this cafe, one, or another, or many, of thefe caufes join'd
together, that it confifts in a kind of relaxation, and this a relaxation which
began twenty years ago and more, as the effects of it fhow, and was after-
wards gradually increas'd.
6. And as from this induction an indication arifes, of reftoring to the re-
lax'd parts that firft and proper meafure of rigidity, or clofenefs of con-
nection, their former fituation, and firmnefs ; fo no perfon, whatever, who
is even flightly vers'd in medical affairs, can fail immediately to perceive, that
it is very difficult, not to fay impoffible, to bring this about. And if, as
Galen has in general taught («), diforders of the anus, or fundament, " are
" very difficult to be cur'd," which was, perhaps, the reafon why fome phy-
licians, formerly, plac'd all their ftudy on the cure of thefe alone (0), with
•how much more difficulty muff this diforder, which is fo ftubborn, and of fo
long ftanding, admit of a cure ? Indeed I do remember to have read of other,
more confiderable, prolapfufes being cur'd, as that was which I have fpoken
of from Muralt (/>).• But 1 do not remember to have read of an inveterate
prolapfus, or one which had afflicted the patient for twenty years, being got
rid of. For which reafon we ought to be fatisfy'd in the prefent cafe, if as
the relaxation cannot be remov'd, we can, by means of the palliative method
of cure, as it is call'd, prevent the daily effects of it, or render them lefs
confiderable, and more tolerable : for thefe effects are not only of importance,
by reafon of the uneafinefs they give, but becaufe they increafe the difeafe,
and alfo becaufe there may be the higheft danger, at one time, or other,
either from the prolaps'd part being very much increas'd, or not being early
replac'd, or injur'd from being expos'd to the air, or finally, from its being
(/) De medic, in praef. (<0 Vid. 1. Galen, adfer. de partib. art. med.
(m) N. 2. c. 2.
De comp. medic. £k. loc. 1. 9. c 6. (/■) N. 4.
Vol. II. Q but
U4 Book III. Of Difeafes of the Belly.
but little confin'd by the fphincter, which in a courfe of time may be relax'd,
and particularly, at that time, when the ftrength of the conftitution, being
broken down by age, will be lefs able to refill this relaxation, or prevent that
which is already prelent, from being farther increas'd.
7. But as I find that the moft powerful medicines, whatever, have been in
vain apply'd, to remove this relaxation ; fo I likewiie fee, that in the pallia-
tive method of cure, many and various inftruments have been made ufe of
in vain, againft the effects of it ; and that, for this reafon, others are re-
quir'd of me, and, in particular, a defcription of that which is faid to have
been invented formerly, by that very ingenious monk Paul Sarpi. But I
fear left: all thele which are known to me, may at length be refer'd to thole,
which have been already made ufe of-, if we confider that which is the prin-
cipal ; and amongft theie that of Sarpi alfo, fince I find no defcription of it
but this, which we read in Rhodius (q)\ " the piles being return'ci back in-
u to their places, fo as not to fall down again, let them be kept there with
" an iron ring aptly applied : which many have receiv'd great advantage
" from, and afcribe its invention to Paul Servita, a Venetian, and a man of
" great ingenuity. This ring is enclos'd, on each fide, with foft leather,
*' which is faften'd towards the perineum, and the buttocks, by bandages
" that are few'd to each of its four heads, being connected with a linen girdle,
" that goes round the waift."
The inftrument of Sarpi, therefore, is of the fame kind with the rings that
have been already made ule of : and that which, not to mention the tabula
angufiijfima " of Hippocrates (r)" is recommended by Riolanus(j), and by
two others among the French, Blegny (t), and Dionis («), and before the
latter, even by Muralt (#), that is to fay, a tablet pierc'd through with a
foramen of fuch a kind, as not to fuffer the inteftine of the patient to pafs
through, when he goes to ftool, is upon the very fame plan : and this ta-
blet Muralt order'd to be enclos'd in a blue cloth, dyed with indigo, not
what comes from Madagafcar, but from the Caribbe Iflands. And what Pa-
rey recommends, amounts, at length, to the fame thing, though without the
application of any inftrument, when he fays (_>'), " if the patient could dif-
" charge the fseces, in an upright and Handing pofture, the inteftine would
" never be in danger of being thruft out, by the ftraining."
But as the patient, whole cafe is now propos'd to my confideration, can-
not unload his bowels, unlefs, fetting afide every kind of artifice whatever,
he fufler the inteftine to come out -, I feem to be throwing away my time, if
I do not endeavour to invent any other artifices of that kind, and do not ra-
ther inquire into the caufe, why the ufe of inftruments, of this kind, is, in
the prelent cafe, without any advantage, fo that this caufe being known,
either the ingenuity of fome fkillful furgeon may be excited, to find out
one of a quite different nature, which might be ufeful, or if be it iound,
upon the inquiry, that this cannot be done at all, that the part affected may,
hereafter, be troubled with no inftruments whatever.
(0) Cent. 2. obf. med. 94. («) Cours d'oper. de cliir. dem. 4.
(>■) Dc fiftul. d. 1. (x) Schol. ck. fupra ad n. 4.
(.') Seel, 1 ;t. i ipraad. n. 3. (y) Cap.c't. fupra ad n. 3.
(/) L'arc. deguerirleshem. p. 2.f.2.c.8.
8. And
Letter XXXIII. Article 8. n5
8. And firft, ir is not to be fuppos'd in the prefent cafe, that the inteftinc
is, necefiarily, to be fuffer*d to come down, becaufc the excrements arc fo
thick and hard, that they cannot pafs through thole inftruments which I have
fpoken of; for ir this had been the cafe, it would have been provided againlt
long ago, and abfolutely prevented from happening, either by a luitable diet,
or by folutive medicines, or by the injection of a I'm all quantity of a liquor,
proper to lubricate, and ibften. It therefore remains, that the relaxation of
the whole inteftinc, or of its internal coat, muft be fuppos'd fo confider-
able, that the one, or the other, defcending, when pufh'd down by the ex-
crements, in a great number of large rugce, laid one upon another, form
fomething like a valve, efpecially as often as being retain'd by any kind of
artifice, it cannot altogether extend, and unfold itfelf, and by this means
give an open pafiage to the excrements. And if this be the real date of the
affair, all artifices of that kind are to be remov'd •, for as, by this means,
that part of the inteftine may be comprefs'd, betwixt the feces which are in-
creas'd above, and the inftrument, no advantage can be expected from
thence, but even a very confiderable injury may, at fome time or other, be
fear'd.
Inftead of thefe inftruments then, a new one fhould be fought after, which
might not only fupport the lower part of the inteftine externally, as the for-
mer have done, but might, at the fame time, reach fo far, as to be able to
fupport internally, and opportunely dilate, the relax'd parietes, that they
may not, by being inverted, and pufh'd before the fasces, in the form of
ruga?, or valves, ftop up the pafiage of thefe faeces, when they are about to
be difcharg'd. It would be neceflary, that this inftrument fhould be of fuch
a nature, as to render it eafy of infertion, into the inteftine, and fhould be
moderately, and gradually dilatable, as foon as ever the neceffities of nature
may begin to require, nor fhould there be the leaft danger of its injuring the
inteftinc, either laterally, or in the upper part of it, but particularly in
the upper part : to prevent which danger, all the upper parts of the inftru-
ment might be inverted, before its introduction, with the foft and frefh in-
teftine of fome little animal.
The well-known contrivance of thofe inftruments call'd fpecula, which
furgeons us'd to dilate the vagina uteri, and even the inteftinum rectum it-
felf, might perhaps, to a prudent, and fkillful, contriver of inftruments,
fupply a much better,* and lefs difagreeable, idea of this inftrument, with
which it would be fufficient to keep that part of the inteftine extended, that
is eafily dilated, I mean the part which is above the fphincter ; and to leave
no larger a pafiage open through this part, that moft refifts dilatation, than
would be fufficient for the foft, and almoft fluid, excrements to pafs through;
for care muft be taken, by a luitable regimen, to keep them, conftantly,
in fuch a ftate.
But as I well know that moft machines, when apply'd to their ufes, gene-
rally correfpond but little with the expectation of the inventors, and as in this
cafe, in particular, I fee what disadvantages might arife, not only if an un-
experiene'd hand fhould introduce the inftrument, and dilate the inteftine,
but alfo from the frequency of the introduction, and dilatation, and even
from the very motion, and comprefiion, of the inteftine, while the fseces
Q^2 fliould
n6 Book III. Of Difeafes of the Belly.
fhould be expell'd •, and as I cannot know, for a certainty, that the relaxa-
tion does not begin higher up, than the inflrrument can reach, I profefs that
I have enter'd into this difcuffion, with no other intention, than to excite
others to look out for a more natural, and commodious idea : and if it were
certain, that this could be reduc'd into pradtiie fafely, and without fufpicion
of any danger, it would then, indeed, be neither improper, nor perhaps
ufelefs, to make the experiment thereof.
9. But if, as I am very much afraid, on account of the caufes juft now
hinted at, it mould be taken for granted, univerfally, and not without rea-
fon, that in the palliative cure, there is no room for the trial of any inftru-
ment whatever, then nothing would remain for medicine to do, but to ex-
amine, whether in the methods of cure, which have been already made ufe
of, in order to remove that relaxation, any remedy had been omitted, by
which, ifthedifeafe could not be overcome, it might at leaft be in lbme
meafure diminifh'd.
10. Many afiiftances were formerly taken from furgery againft this dif-
eafe. Riolanus (2) recommended two cupping-glaffes, to be apply'd, one
to each fide of the lower part of the os facrum, or to the buttocks, as Sena*
cher (a) mentions, who expected fome advantage from thence, when the
chief caufe of the difeafe confifts in the mufcles of the anus being languid.'
Yet I have no more expectation from this practife, than from two cauteries
being apply'd to the lower part of the fpine, which Mercurialis(^), follow-
ing the fectaries of the Arabians, has propos'd, and Marcus Aurelius Seve-
rinus (c) has confirm'd •, unlefs, perhaps, they ought to be apply'd in a per-
fon whofe habit of body was very different from that of our patient's, and in
whom the prolapfus had been brought on, or continu'd, from too great an
afflux of humours to the part.
But as to the famous remedy of that ancient furgeon Leonida, whom the
celebrated man, Daniel le Clerc (d), fuppofes to be the fame with Leonides,
the phyfician fpoken of by Caslius Aurelianus (<?), under the title of Epifyn-
theticus ; I will neither omit the opinions of others, nor conceal my own.
When diet, therefore, had been of no advantage, nor medicines had contri-
buted any thing to the alleviation of the diforder, and the evil was now grown
inveterate, Leonida judg'd it to be neceffary, and not at all dangerous, to
burn the external, and extreme, part of the anus with fome cauteries •, for
that, by this means, a folid cicatrix fucceeding, the anils would be conftring'd
all round, and the prolapfus remov'd. Thefe things may be read fomewhat
more clearly, and diftinctly, in Aetius (f)y who has preferv'd, and handed
down to us, this, and other curative methods of Leonida : and this method
has been taken notice of by Fabricius ab Aquapendente alfo (g)3 and by Ri-
olanus (b).
As to Severinus (i)3 he not only mentions it ; not only confirms, by many ob-
servations of his own, that the actual cautery had fucceeded very happily with.
(2) Seft. cit. fupra ad n. 3. (e) Acut. pad". 1. 2. c. 1.
(a) §. 9. cap. cit. fupra ad n. 4. (f) Medic, tetrab. 1. 4. ferm. 2. c. 8.
(/>) Cap. cit. fupra ad n. 3. (g) C. cit. fupra ad n. 4.
(c) De effic. medic. 1. 2. p. 1. c. 50. (/') Sect. cit.
(d) Hift. de la med. p. 2. 1. 4. f. 2. c. I. (*) Part. cit. c. 95.
him.,
Letter XXXIII. Article it. 117
liim, when applied to this part, though in 01 her diforders; but he calls tin*
phyficians timid; and llothfi.il, became they would not suffer him to apply
the fame method of cure, to a gentleman oi the noble family of the Surgen-
tii, whole prolapsus, like that of our patient, was of twenty years (landing,
and had, like his, received no benefit From all kinds of medicines,
On the other hand, Blegny (k) entirely rejects this kind of cure, as not
lefs troublefome, than urrulual, in our prefent times. And Dionis (/) fays,
that he never law ir, calls the authors of it cruel, and the operation itfelf hor-
rible, even to thole who hear of it: and believes that if there mould happen
to be any medical practitioner, who would willingly try it, no patient, nor
anyone elfe, certainly, would confent to ir, and that with great good reafon, be-
caufe thefe dilbrders may be cur'd without it: although it does not at all ap-
pear, by what means he could prove this sutler tion, as he propofes no remedy
that feems to be equal to the cure of this diforder, in our patient.
However, it is by no means necesTary for me, here, to atfent, either to
the epithets of timid, and llothful, with Severinus, or to that of cruel with
Dionis. For although I do not deny but the method of cure taught by Leo-
nida, may be ufeful in a (mail relaxation, when it is pretty low down, and
that this is, in fome meafure, confirm'd by the obfervation of Cowper, which
is pointed out above (m) ; yet in this relaxation that I am fpeaking of, which
is lb very considerable, and feems to begin lb high up in the intestine, I am
very much afraid that it would not be of any great advantage, if it were of
amy advantage at all.
11. In the mean while, leaving to better judges than myfelf, the farther
examination of thefe methods of cure, which were formerly made ufe of
by furgeons, I go on to confider a more modern instrument, the author of
which testifies its having been very ufeful in many prolapfufes.
This author is Blegny (n), whom I before mention'd, a man truly inge-
nious. He took the craw of a turkey-cock, and tied the orifice of it fast to
one extremity of a fhort, and (lender tube, made of filver ; and at the other
extremity, he introdue'd a stick, which was blunt, at its upper part, quite to
the bottom of that pipe, and by this means, first introdue'd this pipe, and
afterwards a proper part of the tube, daub'd over with astringent remedies,
into the rectum; the remaining part of it he kept on the outfide of the anus,
in fuch a manner, that when he had taken away the stick, and, in the place
of it, had inferted into the fame part of the tube, the pipe of a fmall pair of
bellows, and had driven in fuch a quantity of air, as was fufficient for silling
the craw, the air could not return before the patient was willing, and being,
confequently, retain'd, would fupport the relax'd parts, and caule by its fre-
quent, and long-repeated ufe, that they fliould, as far as possible, recover
their former situation, and strength. But it is better to fee the accurate de-
scription of this instrument, its delineation, and the manner of fixing it, in
the works of the author himfelf.
It is true I agree with Dionis (<?), readily, herein, that even this instrument
is not without its inconveniencies, nor does it anfwer the end of retaining the
{A) Cap. cit. fupra ad n. 7. (n) Cap. pauloante indie.
(/) Demonflr. ibid. cit. h) Demonflr. paulo fupra icdic.
(«) N. 4.
in-
n8 Book III. Of Difeafes of the Belly.
inteftine in its fituation, at that time, when there is mod need of it •, I mean
when the patient goes to ilool ; fince it muft, of courfe, be then taken out,
and foon after be replac'd, when the inteftine has been return'd back again.
Yet I deny that this inltrument produces, as he fays, the fame effect with
bandages, and other external applications. And indeed, excepting the in-
convenience, which is not very confiderable, and that a cautious, and fkilful,
hand is xequir'd to replace the inftrument, I mould fnppofe that it would be
not altogether without its advantage, efpecially in the beginning of relaxa-
tions of this kind.
It might even be confider'd, whether, inftead of that craw, it would not be
better to make ufe of the foft inteftine of any animal, which was furnifh'd
with (lender coats, of fuch a proportion, as to length, and breadth, as it was
convenient, or neceflary, to introduce, having the upper extremity clofely
fhut up internally, and being daub'd over externally, with that medicine which
I fhall recommend below (p)> to be made ufe of after going to ftool : this in-
teftine being thus fufficiently introduc'd, and air being foon after injected, or
even fometimes a liquor of a proper quality, it might be entirely diftended,
or at leaft to fuch a degree, as not to bring on a defire of going to ftool.
It is not ealy, perhaps, to find a more commodious, and at the fame time
a more innocent, remedy than this, in order to replace, and retain, in its native
feat, the relax'd coat of the inteftine, and even the inteftine itfelf, fo that by this
means the ligaments of the inteftine may beeas'd, and, the weight and exten-
fion being taken from them, they may have an opportunity of reftoringthem-
felves, in fome meafure, and regaining their ftrength. However, although
I fuppofe, as I have already faid, that in the beginning of the dilbrder fome
advantage might be hop'd from thence, and, certainly, more than from the
tents, which others apply with the fame view, impregnated and daub'd over,
with aftringent remedies-, yet what ufe may be expected from it, in an invete-
rate difeafe, I confers, I do not lee.
12. As to pharmaceutical remedies, it becomes me to be fo much the more
fhort on this fubject, as I am inform'd by the letter of the phyfician, who
confults me, that all the medicines have been already made ufe of, that could
poffibly be devised, whether of the agglutinating, vulnerary, or aftringent
kind, or fuch as help the nerves •, and as I fee that all the books, both of
phyficians, and furgeons, are full of remedies of that kind. And although
I fee that, in the fame letter, fomentations, femicupia, injections, cerates,
fumigations, and other external forms of medicine only, of the fame kind, are
taken notice of; yet I do not doubt, but internal medicines, correfpondent
thereto, were us'd at the fame time. And, indeed, I very clearly conceive,
that what could not hitherto be obtain'd by thefe remedies, is muchlefsto be
expected from them hereafter, as the dilbrder is, in the mean while, become
.more confiderable, and the caufes of it more confirm'd.
Neverthelefs, as long as the life, and the ftrength, of the patient, are in
a flourilhing ftate, the cure, perhaps, ought to be repeated •, for it is certain,
that a long-continu'd, and vigorous, method of cure, repeated cautioufly,
and prudently, could never be of any difadvantage. And in this regimen,
.(/) N. 13.
fliould
Letter XXXIII. Article 13,
1 1
mould be included all the moil corroborating medicines, which however
fliould be taken from the clafs of thole that aflift the nerves, rather than from
thole that have ftrongly aflringent properties •, for the feces being hardened
by thefe, the patient mull, of courfe, make ufeof more violent, and a greater
number of, (trainings, in going to llool, whereby the dilbrder would be more
i\\u\ more increas'd. For which reafon, likewife, all thole medicines are to be
rejected, that are call'd purgatives ; for they lead to the injur'd part, and.
C very troublefome, and noxious, irritations therein. But if it is necef-
fary to loolen the belly, fuch things mull be made ufe of, as will be prefent-
ly taken notice of in the diet, or fome things fimilar to them, that are quite
innocent. And in regard to remedies, that are to be externally apply'd, I
fliould greatly prefer, as to the form, the femicupia, and injections-, as to the
matter, the ftrengthening waters of warm baths.
13. It remains to fpeak of diet, as a proper regimen,, in this refpect, is
altogether neceffary, fince it not only afiifts the effects of the remedies, which
are taken from furgery, and pharmacy, but alio becaufe, if thefe remedies
are not at all repeated, or repeated to no purpofe, there is then no other me-
thod, befides this, remaining, by which we can endeavour, with the greateft
eafe, fafety, and frequency, to render the diforder, at lead, lefs troublefome,
or leffen its danger. Mercurialis propofes fuch a kind of diet (<?), as has a
drying property : and there is no doubt but this regimen conduces much to
ftrengthen the habit : but if we confider, and well-weigh, the very great, and
frequent, inconveniencies, which would arife from the inteflinal feces being
harden'd, by fuch a method of living; it will certainly feem to us, and efpe-
cially after corroborating medicines have been fo long made ufe of, to no
purpofe, that a mode of diet which is of a moiil, and foftning nature, is to be
prefer'd to that which is fo powerfully drying, as fuch a regimen would ferve
to keep the excrements foft, and, at the fame time, correct their acri-
mony.
That very cautious phyfician, Francifco Redi (r), in his advice againft a
hemorrhoidal flux, and pain, join'd with a prolapfus of the inteftine, at the
time of going to ftool, order'd meat-broth to be drunk in a morning, to the
quantity of half a pint, without any fait, and in this broth he order'd to be
previoufly boil'd, a pretty large quantity of violets, and after thefe could be
no longer had except in a dried ftate, he order'd, in their (lead, fuccory, or
borrage, or buglofs, or fow-thiftle, frelh or dried prunes, quinces, or fome-
/thing of the fame kind. He recommended the ufe of depurated whey, fweet-
en'd with a julep, made either from the tincture of freih violets, or quinces.
He alfo recommended the ufe of affes, or goats milk. At dinner, and flip-
per, amongfl other things, he order'd a pudding to be a conftant difh, but
this was to be very fimple, and to confift chiefly of broth, in which apples
had been boil'd, or fome herbs of the number mention'd above, and fome-
times alfo a little barley, or rice. He prefer'd boil'd meats more frequently
than roaft. And omitting aromatics, and wine, he order'd dinner and fupper
always to be concluded with a fcalded apple, or a bak'd pear, drinking after
it three ounces of water, fweeten'd with a fyrup, made from citron peel.
(l) Cap. cit. fupra ad n. 3.
4
(r) Opere dell' ult. ediz. t. 4. verfo il fine.
From
120 Book III. Of Diicafcs of the Belly.
From thefe things that I have related, as they (land in the opinion of
Redi, I mould not recede much in this cale, or, at lead, only fo far, as to
prevent the bowels from being too much operi'd. But if that regimen of
Redi's were not fufficient, for it ought, by being continu'd, to be fufficient
to keep the belly fo far lax, as to prevent there being any neceffity for
ftraining, or for fitting long when the patient goes to ftool ; then, indeed, I
fhould not be againft imitating Recli, alio, in giving two drachms of the
pulp of cama fometimes, which fhould be taken in the morning before the
broth, of which I have lpoken, and repeated again, in the fame quantity, a
little before fupper, if the former had as yet produe'd no effect. But if, in
fpite of this regimen, the excrements, neverthelefs, ftill continu'd hard and
dry, I fhould judge that they ought not to be difcharg'd, by the means of
ftraining, but by the afiiftance of glyfters.
Yet thefe glyfters ought not to conlift of more than half a pint in quanti-
ty, that they may be retain'd, with the greater eafe, for a proper degree of
time, and-ought to be made up of broth alone, or the barley emulfion, as it
is call'd, or an emulfion of rice, which had been previoufly hah>burnt, as it
were, and boil'd, and this alfo in imitation of Redi. Who, finally, gives
great commendations to a certain yellow ointment, (call'd manteca) and
■made from roles, fuch as was prepar'd by the perfumers of the grand Duke
of Tufcany, affirming, that the prolaps'd intefline is much fooner, and more
eafily, replac'd, if the extremity of it is fmear'd over with that ointment,
by which, befides that the pains being alleviated, he fays that the injur'd,
and debilitated, part will be, not a little, corroborated.
However, the replacing of the inteftine will be render'd lefs difficult, by
the method of living prefcrib'd, and the fparingnefs of diet. For by this
means, neither a quantity of excrements will be accumulated in the neigh-
bouring tract of the colon, which is a circumftance, that is generally a very
confiderable obftacle to the return of the prolaps'd inteftine, nor will blood
be generated, which either by its redundancy, or from any other diforder
whatever, can tend to render the weak part preternaturally thick. And as
this may, alfo, happen from violent motions, and excrcifes, it will be equally
necefiary to avoid thefe likewife •, and, to comprehend the whole, in a few
words, every thing ought to be difus'd, which experience itfelf, much better
than the advice of any phyfician, has, through the long courfe of fo many
years, demonftrated to be injurious.
14. Thefe things I had to obferve, in regard to the very difficult cafe, up-
on which my opinion was requefted, hoping that the learned, and noble pa-
tient, on whofe account they are written, will be fo condefcending as to ex-
cufe the hafty manner of putting them together, as I am, at this time, much
taken up with many, and various puriuits, and that the very experiene'd
phyfician who confulted me, will make what ufe of them he fhall think con-
fident with his prudence, and the circumftances of the patient : and I beg of
the almighty God that he will fuccecd whatever may have been, or fhall be,
determin'd upon.
15. You have, here, the opinion juft as I wrote it. at the time, that is in
the year 1725, on the thirteenth day of Auguft. In which, befides the pro-
lixity, there are other things, wherewith I am not very well pleas'd, at pre-
4 font.
Letter XXXIII. Article 15.
121
fent. But as it happen'd that I was to write on fubjects little treated of, I
could avoid neither the one nor the other. And I could wifh there had been
any one, fince that time, whole anatomical obiervations would have fet this
affair in its defirable light. But their obiervations, as they were then un-
known to the very learned Schacher (s), and to me, lb they are ft ill unknown.
And what circumftances are to be inquir'd into, particularly, in the bodies of
thole whole inteiline has been accuftom'd to defcend to a confiderable length,
will be fhown by the foregoing opinion, yet perhaps not all. For who knows
whether thole ligaments, which refemble three (mall bandages, going from
the upper part of the rectum, into the neighbouring colon, are not, fome-
times, relax'd by too great moillure, or drawn afunder by the quantity of
excrements, which is gathered together; or, by the violent and long-continu'd
trainings, to dii'charge the feces, do not only fufT'er, in confequence of this
diltraction, ibme of the laft cells of the colon, but alfo a great number of
thofe tranivcrie rugrc, which are within thefe cells, to be extended, fo as to
increafe the length of the prolaps'd inteftine.
Care mud be taken then, wherever bodies of this kind, which I fUJl
much wifh for, fhall happen to be diffe&ed, to inquire, accurately, into the
ftate of thefe ligaments, and cells, or if both of thefe parts are in their na-
tural fituation, to fee whether the internal rugs, at leaft, are not unfolded,
and almoft evanefcent, which circumftance alone, would fuffer the internal
coat, wherein they are, to be fo greatly extended downwards, that is, in con-
fequence of being drawn, by the internal coat of the inteftinum rectum,
which is a continuation of that of the colon, and which, in my Covfilium (t), I
have fuppos'd, following after the modern medical writers in particular, may
be thus inverted, and prolaps'd outwardly. Yet, at the fame time, I think
it ought to be inquir'd in thefe very bodies, how far this inverfion may really
happen, or be allow'd of, as I have many doubts upon this head.
For the queftion is not at prefent, as it was on a former occafion (#), of
one part only, and that to be compar'd, in fome meafure, with a kind of cu-
ticle, as it were, which is feparated, but of the whole internal coat of the rec-
tum : and that this fhould be let loofe from the mufcular coat, lb as not to be
a dead part, nor yet to have any very violent fymptoms join'd with it, is dif-
ficult to be believ'd among thofe who have obferv'd the innumerable, I do not
fay, fmall fibres ancl nerves, but only the innumerable little arteries, and veins,
by which one is join'd to the other.
Whether, therefore, thefe fmall vefTels can be fo relax'd, and extended,
by degrees, as the great inverfions of the internal coat particularly require,
which many fuppofe to happen in this cafe •, or whether the example of tu-
mours, in which it is certain that a great extenfion of the* velieis does really
happen, takes place here, where the internal coat is faid to grow thick indeed,
but flill to be preferv'd flexible, and in a proper date to be replac'd ; or
finally, whether thefe inverfions, which are generally fuppos'd to be of the
fame nature in the rectum, as in the vagina uteri, are in fact of the fame
nature, and how far, will never be learn'd with more certainty from any
thing, than from a very accurate difTection of thefe bodies. Nor indeed
can the opportunity of differing bodies of this kind, be very rare, and
(s) §. 3. cit. fupraadn. 4. (') N. eod. («) Epift.
Vol. II. R
31. n. 20.
efpe-
122 Book III. Of Difeafes- of the Belly.
efpccially in great cities. For this difeafc is fatal to many, that is, in confe-
quence of inflammation, and gangrene, ieizing upon the inteftine, when the
replacing of it has been too long neglected. But it alfo, fometimes, happens, in
thofe who have been taken off" by other kinds of death, that many things
offer themfelves, the examination of which may be ufeful, in refpect to this
matter, whether they have been liable to a prolapfus of the inteftinum rec-
tum, or whether, from any cauie whatever, as, in a certain common fcldicr
(x), " a prolapfus, or devolution, of the colon into the rectum," occurs, which
in him was " equal in length, to a fpan." And Salmuthus (y) did not
doubt, but the colon, as well as the rectum, might be prolaps'd, when to
the observation of a fucking child (z), who fore'd the inteftines out at the
anus, in a violent epileptic paroxyfm, " to a very great length," he prefix'd
this title, " a procidentia of the inteftine colon from an epilepfy."
I wifh he had diflected the body of that girl, who was about fourteen years
of age (a), in whom, from the neglect of a very violent tenefmus, " the
" whole inteftinum rectum, with a part of the colon, was fore'd out at the
" anus, to the length of two fpans and more." For as it could not be pro-
perly reftor'd to its natural fituation, and as a gangrene had already feiz'd
upon the extremity of the rectum, me died, he himfelf being furpriz'd, how
fo great a portion of the inteftines could have fall'n down, from the mefen-
tery. But if many, and various, bodies could, at length, be accurately dif-
fered, either of thofe who died of a prolapfus, that had then afflicted them,
for the firft time, or of one which they had been troubled with before, or of
thofe who, as they had been fubject to the fame prolapfus, and that gradually
increas'd to a great length (£), were differently affected with difagreeable
fymptoms, and different kinds of uneafinels arifingfrom thence, of whatever
dilbrder they may have died ; it is not to be doubted, but it mud be
much more eafy for phyficians, to point out the caufes, and cure, of this dif-
eafe, when confulted thereon.
1 6. But as the conditions of the cafe then proposed, led me, in the theo-
retical part, to fome things which are perhaps not very probable, fo in the
other part alfo, they naturally led me to many, which may be much more
eafily wifh'd for, than brought about. But if the patient had not lain under
that peculiar neceffity, of removing every inftrument, or artificial contrivance,
from him, and fuffering the inteftine to be prolaps'd, when he wanted todif-
charge the faeces, affiftance would not have been wanting, which I could
propofe, to keep the inteftine in. its natural fituation, while the fceces were
idifcharg'd..
There was, in the firft place, the ring of Sarpi : in regard to which, be-
fides what I have related above (c), from Johannes Rhodius, I alfo remem-
ber to have read thefe things, in the life of Sarpi ; that when he had long la-
bour'd under this difeale, and had, at different times, tried a great number
of remedies, but all in vain, he, at length, began to inquire after a kind of
inftrument, whereby he might retain the inteftine, for which reafon, after
many attempts, he had, at length, found out one fo proper to the purpofey
(*) Att. n. c. torn, z.obf. 103.
(y) Obf. raed. cent. 1.
(a) Obf. 30.
(*) Vid. Epifl. 65. iu6.
CO N. 7.
that
Letter XXXIII. Article 16. 123
that, although he |abour*d under the dilbrder to the very end of life, he
did not, for that reafon, fuller an impediment of any action, any more than
if he had been without the difeafe, and that the fame was fo fimple in its
contrivance, and fo ealily apply'd, that it had equally the lame effect with
Others, to whom he had communicated it.
But if this life, by reafon of the author's (whoever he may be now (up-
pos*d to be, by a verv great man, who will be commended in another place),
I fay, if by reafon of the author's real, or craftily-pretended, ignorance of
fome things, fo that in the Epiftolae Anatomicae (//), I was willing to make no
other ufe of this life, than for the lake of refuting by means of it, ad bomi-
nem as the phrafe is, thofe who had laid this real or pretended ignorance to
his charge-, if therefore it fhould be fufpected in this point likewife-, another
inftrument would not have been wanting, which 1 had feen taken notice of,
in a certain opinion of our Valfalva's. That is to fay, when the patient went
to the ciofe-ftool to difcharge his excrements, a cover for it was at hand, per-
forated in the middle, and there furnifh'd with a leaden tube, which was
firmly fitted to the aperture, and fmear'd over with wax, externally, and on
the upper border, not wider than two-third parts of the inch of Bologna,
and about two inches long, but not to be admitted into the rectum above an
inch and a half, nor without the affiftance of a cautious furgeon, when the
firft experiments of it were made, fo that if they fucceeded happily, nor
any thing was to be alter'd in the dimenfions of the tube, the faeces might
be difcharg'd in this manner, and the inteftine not pufh'd out.
But if neither of the inftruments had anfwer'd our expectations ; for
you perceive, even from the hints I have given in my opinion, what inju-
ries, not to fay what uneafinefles, might fometimes arife from applications of
this kind ; there were ftill others befides thefe, that might be thought of. For
you fee, by way of example, what a kind of ring was invented, by the cele-
brated Baffius (e), which, " without being any obftacle to the difcharge of
M the fasces," is worn without any trouble, as he fays, and after it has
remov'd the difeafe, may be as eafily taken away •, for he afierts that it had
remov'd the difeafe, and that when it had been of long {landing, in a fhort
time, even within the fpace of two months. But let thefe things be fufrL-
cient upon the fubject of the prolaps'd inteftinum rectum. In the next letter
I will go on to confider other difeaies. Farewell.
{d) 15. n. 68. (<0 Dec. 1. obf. 4.
n 1 LETTER
124 Book III. Of Difeafes of the Belly.
LETTER the THIRTY-FOURTH
Treats of Pain in the Inteftines.
ALTHOUGH the greateft part of the obfervations, of which the four-
teenth fection of the third book of the Sepulchretum Anatomicum
confifts, relates to pains of the inteftines ; yet there are even many therein,
which relate to other viicera of the belly, and in both thefe claffes are ibme,
in which, not internal caufes, but fuch as came from without, blows, for in-
ftance, and wounds gave rife to the pain. This example I do not choofe
to follow, as I have treated, or am to treat, of pains in other parts of the
belly, on other occafions, and of each in its proper place, and am likewife
to write feparately, hereafter, of blows and of wounds. And I am alfo un-
willing to be troublefome by repetitions, which are fo far from being avoided
in the Sepulchretum, that, in this very fedion, we find many obiervations
fet down twice (a), and in the additamenta, to the fame feclion, we find, by
reafon of not detecting the tricks of Blancard, three repeated under his
name, that is to fay, the fifteenth, the fixteenth, and the twenty-third, the
two laft of which had already been given in this very feclion (l>), as the firft
had been in the preceding eighth feclion (t), in the names of their real au-
thors.
Nor is it my intention to imitate the author of the Sepulchretum, in di-
viding my obfervations into two clafles, that is into thole which relate to the
colic and to the iliac pain ; not that I altogether difapprove this divifion ;
although Diodes Caryftius, as Celfus teaches us (d), nam'd the difeafe, not
of the fmaller, but of the larger interline, jrXscv ; and Alexander Trallianus,
as you have it in Salius (*"), judg'd " that the iliac paflion was nothing more
" than a heightening, and increafe, of the colic affection," and Salius mows *
that the primary feat, and caufe, of the ileos might be in botli of thole in-
teftines ; but becaufe it is not fo eafy as many imagine, to diitinguifh the
pains of one inteftine, from the pains of the other, and, confequently, not
very eafy, by means of the figns, that have beenobferv'd in patients, to di-
vide the obiervations of this kind with fufficient clearnefs, and precifion.
2. For in regard to the iliac pains being faid to be more fevere, than the
colic pains, as without doubt they are, whether you fuppofe this to arife, from
(a) Confer, obf. i. §. z. & obf. 20. §. 14. (£) Obf. 20. §.12. obf. 3.
obf. 1. §. 13. &obf. 24. $. 2. obf. 1. §. 14. & (rj Inaddit. obf. 5.
cbf. 19. §. 4. obf. 2. §. 1. & 2. obf. 5. §. 2. & (rf1) De medic. 1. 4. c. 13.
fchol. ad §. 8. obf. 19. obf. 8. §. 1 1. & obf. 14. (e) De affett. partic c. 1 1.
§. 3. obf. 28. & obf. 30. §. 4. * Jbid.
the
Letter XXXIV.
Artiele 3.
125
the quantity ofvcifcls, by reafon of which, the final] interlines arc more fre-
quently found to be inflarn'd, than the large, or whether you rather fuppofe
•[ to arife from the number of the nerves, efpecially it" the villi, with which
the ini2)l inteftines abound, to fo great a degree, are CO be refer'd to the clafs
of paptlke; $1 feaftj there is no doubt, but one perfon is more impatient
of pain than another, and the caufe of pain is different in different perfons, and
in fome lefs violent than in otHeTS } fo that it is not ealy to determine, which
is really tortur'd with the moll excruciating pain: and from hence, perhaps,
it arofe that Galen, fome pafiages of whole works, That are contradictory to
each other, Ballonius itudies to reconcile, has in one piaCv feid, as you fee
in this left ion ot the Sepulchretum (f), that the iliac diforders weTP thj "\oft
violent, and in another place, that the colic diforders were the mod vio-
lent.
But as to the vomiting, which he has aflerted to be the mod violent, an*?
continual, in the iliac paffion, you will find that thofe colic pains are juftly
excepted in the Sepulchretum (g), which have their feat in that part of the
colon, where this inteftine lies contiguous to the fundus of the ftomach.
And not to lead you away from the Sepulchretum, you may likewife
be warned from thence (b), how liable to exceptions frequently, and, for
this reafon, fallacious, that fign may alio be, which, in other refpects, feems
to be the chief, I mean that which is taken from the very fituations
of the fmaller, and larger interlines. For you will find the words of Fran-,
cifcus Sylvius teaching, " that the colon is often carried, through " the
" middle of the abdomen, to the navel, and fometimes even quite to the
" bladder, by a confiderable deviation from its more ufual courfe." And
if it be true, that when the colon deferts its own proper fituation, it takes
up that of the fmall inteftines ; you plainly perceive how much he may be
deceiv'd, who depends greatly on the refpe&ive fituations of thefe vifcera,
in determining the diforder. And not only they, whom Sylvius argues
againft, will be then deceiv'd, but they, alfo, who follow Sylvius. For when
that part of the colon which generally runs in a tranfverfe direction, to the
direction of the body, and lies in contact with the ftomach, is not really in
that place, but is fo remarkably inflected downward; there is no doubt but
thofe perfons mult err, who deny that this part of the colon is feiz'd with
pain, by reafon, that the pain, and torture, do not run acrofs the upper
part of the belly, like a belt-, and they alfo will, of courfe, blunder, who
fuppofe, with Sylvius, " that a pain which has its feat in the circle, and
" circumference, of the belly, is truly of the colic kind ■" for the pain,
which then arifes, in the upper circle of the belly, cannot have its feat in
the colon, which is not in that part.
3. And that what Sylvius has warn'd us of, does, in fact, frequently hap-
pen to the colon, not a few of the obfervations, both of Valfalva, and of
mine, which have either been already propos'd, or are to be propos'd here-
after, will confirm : although I have not had, nor fhall have, occafion to
take notice of, in thefe letters, all the bodies in which I have found it thus ;
for it is long fince that I began to obferve this variation, even before I hap-
(f) Schol. ad %. 5. obf. 5.
(g) Schol. ad §. 2. obf. 25. in fin.
{J}) Schol. ad obf. 41.
pen'il
126 Book III. Of Difeafes of the Belly.
pen'd to light on this pafiage of Sylvius, as the fecond of the Adverfaria will
demonftrate (/'). But in the third of the Adverfaria (k), I have alfo obferv'd
another variety, in the lower fituation of the colon, which is by no means to be
pafs'd over here : although there, in like manner, for the fame reafon, I
could not, according to my cuftom, commend thole who had obferv'd it be-
fore me, Spigelius (7), and Riolanus {hi) ; to whom, however, it feems to
have happen'd, contrary to what has occur'd to Valfalva, and to me, that
the colon has been, more frequently, winding in its termination, and has
more rarely taken a pretty ftrait, and fimple courfe.
But be this as it will, as thefe flexures not only extend the colon, in fome
bodies, towards the right groin, but, fometimes, as I have feen, raife it up
by means of flatus to a turgid ftate, and particularly at the navel •, it certainly
appears from hence, how eafily the pain, which is in that inteftine, may be
then, without reafon, fuppos'd to have its feat in the fmall inteftine, of which
this place is the common and natural feat. Both thefe fpecies of variety then,
are not uncommon, whether from the firft formation of the body, or even
from dileafe, as the words of Riolanus obfeurcly hint («) : thefe words are,
*' I have fcen the inteftinum colon, not ftretch'd out, directly, betwixt the
" liver, and fpleen, but inflected in the manner of an Italian S, and PRO-
" LAPS'D quite to the navel :" and Spigelius (o), fpeaking ftill more
clearly, and more generally, fays, that the fame inteftine " when preterna-
*' turally diftended with flatus, in colic pains, is remov'd from its natural
" fituation." But if you choofe to fuppofe, that, for this reafon, it was that
I found, in an apoplectic woman (p), who had been fubject to thofe pains,
the colon not only with fewer cells than ufual, but alfo writhing itfelf with
larger turns than it generally does, in its extreme part, towards the navel,
I fhall not contend with you upon the fubject, efpecially as I fee, from the
obfervation which, in this fection of the Sepulchretum, is the fifteenth, and
is read more at large in the ninth fection, of the firft book, where it is the
forty-eighth, as I lee, I fay, that Francifcus Sylvius had fuppos'd another
woman to have labour'd under the fame excruciating pains, not fo much be-
caufe the omentum did not, as he had remark'd, cover all the inteftines, or
becaufe thefe were fomewhat mov'd from their places ; for the latter occurs
pretty often, and the former very frequently-, as, unlefs I am much deceiv'd,
becaufe he had found, in the fame woman, both the fpecies of variety which
are juft now explain'd.
However, if the fituation of the inteftine colon were chang'd, only from a
caufe of that kind, yet the danger of erring would be fo much the more to
be fear'd, as the queftion about thefe fituations, is for the moft part in thofe
perfons, who are wont to be fubject to that caufe. But in thofe perfons,
like wife, in whom the ftomach is much dilated, and the liver enlarg'd in its
fize, that tranfverfe part of the colon, which lies under thefe vifcera, muft
be lower, in the fame proportion as they are enlarg'd. Add to thefe, fuch
caofes as deprefs the ftomach, and with it the colon, as I have feen it hap-
(/) Animad. t. (//) Ibid.
(/£) Anim. 6. («) C. cit.
(/) De hum. corp. fabr, 1. 8. c, j. {J>) Epifl. 3. n. 3,
(m) Anthropogr. 1. 2. c. 14.
pen
Letter XXXIV. Article 4, 5, 6. 127
pen in a VQUg man of Venice (7), from a very irregular inflexion of the fpine.
But befides dileales, there arc alio naturally different constitutions of bodies, and
in theft dvfferentcqnftitucipns* different fituations of the colon. For even from
the birth, as w-ls hintpdjuft now, it may be differently plae'J, and in gravid
Women, when the uterus is lb much incrcas'd in its fize, in the lad months-
of pregnancy, that traniVcrfc part of the colon is higher, as Spigelius ob-
ierves (r).
4. And theft things being granted, and it appearing ftifficicntly from
hence, why I do not divide the obfervations relating to pains, with which
the bowels are tortur'd, in Inch a manner, as to clal's fome under the title
of iliac, and others under the title of colic pains; it remains to point out the
divifion, which I choofe to make ufe of. Firft then, I will give thofe in which,
there were pains from a caufe that did not proceed from without indeed, but
nevertheless was vifiblc; and in the fecond place, thofe, in which the caufe
lay hid quite within the body. And thefe two of the former kind I give you
from Valfalva.
5. A man of forty years of age, of a temperament partly fanguineous,
and partly bilious, who had, fometimes, been affected with a flight hernia
in the groins, was feiz'd with an iliac paffion, after eating artichoaks. A
flight tumour appear' d in the groins : yet the patient denied his having any
pain there-, though he confefs'd he had much pain in his belly, which was
very much harden'd from the retention of the feces. All remedies being with-
out effect, he fank under the violence of the vomitings, on the feventh day
of the difeafe.
The belly being open'd, the inteftines appear'd to be turgid with air, and
were livid and black, in that part where, not very far from the caecum, they
were doubled, and with the annex'd portion of the mefentery, which feem'd
to be flefhy, as it were, defcended into a hernial facculus, which was four
inches long, and had a very narrow orifice, fo that they could not return
back through it, into the belly, after they were diftended by the matter, than
had fallen down into them. This facculus was in the right groin, and
form'd out of the peritonaeum indeed, that was produe'd and dilated, but
not from a procefs of it •, as many believ'd formerly ; which accompanies
the vas deferens, and fpermatic vefTels : and it even lay, anteriorly, upon
this procefs, and thefe vefTels, which were very tumid with blood : and
was, internally, as the intercepted portion of the inteftine was, of a blackifh
colour, or rather ting'd with a black that began to change into green, as if
the colour had been given by a tincture of vitriol. And in the left groin
was another facculus, very much fimilar to the one I have defcrib'd, except
that the membrane, of which it confifted, had its fibres, and vefTels, not
alter'd in their colour, or other qualities,1 from their natural appearances.
In the thorax every thing was found. Yet in the heart were polypous
concretions, of a yellowifh colour, with grumous blood, one pretty large, in
the right ventricle, and another fmaller in the left ; but neither of them was
produe'd out of the ventricles.
6. There was an evident caufe of this pain, that is, according to the com-
mon phrafe, an incarcerated hernia. Of which there will be frequent men-*
(?) Epift. 4. n. 16.
(0 C.cit.
lion
128 Book III. Of the Difeafes of the Belly.
tion made in this letter •, but only as far as a part of the interline being com-
prefs'd, is the caufe of flrangulation to the vefTels of this comprefs'd part,
and the parts nearefl to it: and the manner in which pain, inflammation,
and fphacelus, are brought on from hence, it is by no means necelTary to
explain. Other circumflances in regard to hernias, and the portion of the
peritonaeum, which accompanies the fpermatic vefTels, I fhall fpeak of elfe-
where (j). But of the iliac paffion, I fhall treat at different times, in this
letter, as much as will be fufficient for our purpofe. But now you readily
conceive, that where this diforder arifes, as it for the mofl part does, when
an intefline is intercepted, and comprefs'd, that then the upper inteftines are
of courie diflended, by the matter, which is heap'd up above the intercep-
tion, and that from this diflention another caufe of pain arifes, which is alio
increas'd by the very corruption, of the matter collected, which corruption,
is the coniVquence of flagnation.
But how fhall we fuppofe it to have happen'd, that in the hiflory I have
given you, the patient fbould deny the exiflence of any pain, in that part
where the diforder was the greatefl ? Was it becaufe a fphacelus had feiz'd
the intefline which was intercepted, without any previous inflammation ?
For whether this could happen, we fhall fee on another occafion (7), or rather
was this the reafon of the patient's denying the pain, that the inflammation
had already degenerated into a fphacelus ? For there are other things alfo in
that hiflory, as it is written by Valfalva, which fhow that it was not very ac-
curately committed to paper.
Yet he does not make the leafl mention of pain, even in the next hiflory ;
though the very cafe will, of itlelf, fufficiently fhow, whether pain could be
abfent, or not.
7. A man in his fiftieth year, who labour'd under an enterocele, was
feiz'd with an ardent fever, and, after fome days, with a vomiting of hu-
mours, which feem'd to be ting'd with foot, as it were : he at firll made
water with difficulty, and after that made none at all. The catheter was
introduced by the furgeon, but to no purpofe •, for when it came near to the
bladder, it met with an obstruction. Wherefore being troubled with thele
fymptoms the patient died.
The belly, and the fcrotum, being difTected, the inteftines, which were
fallen into the fcrotum, were found to be affected with an inflammation :
and notwithflanding there was no ulceration in them, yet a little fanious
ferum was fee n in their interfaces. Some traces alfo of a fanious humour, of
that kind, were feen in the pelvis of the abdomen. The bladder was full
of urine, although it had no mark of injury internally. And the obflacle which
was near the bladder, and had prevented the furgeon from introducing the
catheter, was found to be nothing elfe but one of the foramina, by which
the femen is difcharg'd, dilated to fuch a degree, that the extremity of the
catheter, naturally, fell into it : for the fame thing happen'd to the probe
alfo, which was introdue'd, in the dead body, through the urethra that had
been in part, laid open, in order to examine into this very circumflance.
{s) Ejuft. 43. n. 6. & 7. (/) EpilL 35. n. 19. Sc feq.
2 8. Is
Letter XXXIV. Article 8, 9. 129
8. Is it not more probable, chat this foramen was the finus in the Icminal
caruncle, fince defcnb'd by me, which,, in this man, had been immoderately
enlarg'd ? For if it had been one of the feminal duels, it feems that the man
mud have labour'd under a flux of this kind. And there is no doubt but the
orifice of that finus is fometimes bigger, and fometimes lefs, which has alio
been obierv'd by the celebrated 1 lenrieus Baffius («). But it never more
happen'd to mc, as far as I now can call to mind, from the time that I pub-
lifh'd upon this finus, in the year 17 19 (x), though I fhow'd it every year
in the theatre, and fometimes in more than one body, that I found any fe-
minal duel, which open'd into it, and Hill lefs that it feem'd to me, as it did
to him, that " this hiatus was fometimes only a flight fifTure, or fulcus,
which appear'd after thefe parts had fhrunk, and become flaccid.
But whether the caruncle within which this finus lies, as well as the finus
itfelf, was enlarg'd ; and whether, by this means, the orifice of the finus
might, perhaps, be able to obftrudt a very flender catheter, and likewife caufe
a fuppreffion of urine, although the fuppofition is probable, yet as Valfalva
has added nothing befides, I fhall the more readily leave it undetermin'd :
becaufe •, to fay nothing of the caufe taken notice of by Waltherus (y) ; when
the neighbouring parts are greatly affected, it is not very unufual, for the
bladder to be drawn into confent, and not expel its contents, fo that Sen-
nertus (2) recounted this among the figns of inflammation of the inteftines :
and indeed Cadius Aurelianus (a) plac'd, formerly, among the reft of the
evils that attended the ileos, " a total fufpenfion of the offices of the blad-
der and belly." But of the fuppreflion of urine I fhall fpeak hereafter.
Now let me fubjoin to thefe two obfervations of Valfalva's fome of my
own.
9. A young man whofe occupation was that of a hufbandman, had had a
rupture of the intefline into the fcrotum, in the right fide, but as the in-
teftine, was remov'd from thence, replac'd, and retain'd, by means of a
bandage, or trufs, he fuffer'd no injury from thence till the ufe of that re-
tentive bandage was omitted. This however being at length omitted, it
happen'd, after he had been troubled with an intermitting fever, for about
two months, and had lately fill'd himfelf with hard flour dumplins and other
grofs food of the fame kind, that the intefline fell down again, into the fame
place. And from that very day, which was the laft of October in the year
1705, he began to be feiz'd with a vomiting of a bitter matter. On the
fourth day of the difeafe, a fingultus came on, and a pain of the fcrotum.
A fotus of warm lixivium being applied to the fcrotum the pain feem'd to be
fomewhat alleviated. But as the vomiting and the fingultus continu'd, and
he was, befides, troubled with pains of the belly, and a thirft, he was
brought, on the fixth day, into the hofpital of St. Mary de Morte at Bo-
logna.
But there the hand of the furgeon was not of any advantage ; and the re-
medies of the phyfician gave only a little alleviation. For the fingultus was
(«) Dec. j. obf. anat. 5. §. 9. (z) Medic, praft. 1. 3. p. 2. f. 1. c. 2.
(jt) Adverf. 4. aniniad. 3. («) Acut. pafl". 1. 3. c. 17.
(_>■) Differt. de collo villi, vefics &c. §. 3.
Vol. II, S remov'd
i 30 Book III. Of Difeafes of the Belly.
remov'd, as the vomiting was alfo ■, but the latter only for a fhort time, when
the emplajlrum de crufta panis, as it is call'd, was apply'd to the region of the
ftomach, and a glyfter was thrown up made of the oils of linfeed and violets.
I firft faw him on the feventh day. There was a flight pain in the lcrotum. I
heard that the pulfe was lefs frequent, than it had been the day before : but
it was lower, and more weak, than was fuitable to fo young a man. His
third ftill continu'd. Nor did he dilcharge any fasces, except when the oils
I have mention'd were injected.
And, indeed, after they had, on this very day, made ufe of a carminative
decoction, as it is call'd, by way of glyfter, to which fome clarified honey was
added, with two drams of the electuary, that is known by the name of ber.e-
dicla laxaliva ; the vomiting of bitter matter return'd, in which there v/as a
round worm ; but the glyfter did not return till after many hours. On the
eighth day, another worm was difcharg'd. The abdomen being tenfe, and
relbunding, as it were, under the hand, after the manner it does in a tym-
panites, which I had alfo oblerv'd the day before, it did not fuffer any pain
from pretty rough handling, not even in the epigaftrium, where the patient
felt a kind of little biting pain. When I afk'd him whether he felt any heat
likewiie, he anfwer'd in the negative. The pulfe was, in other relpects,
fimilar to that of yeflerday, but much more frequent. His tongue was dry.
His urine had a faturated colour. Under his eyes was a lividnefs, and, even
without this, his face had a very unfavourable appearance. The night fol-
lowing was reftlefs.
On the ninth day, every thing was in the fame ftate : the countenance
and pulfe were even worfe. For the latter was ftill more frequent, but when
you prefs'd it, it gave little or no refiftance. And the former was nearly of
the fame kind with that which you call the facies Hippocratica. And though,
the patient had been troubled with an anxiety on the preceding days, had
a feeble and lamenting tone of voice, and was every now and then changing
tbe fituation of his body and his limbs, yet all thefe fymptoms were ftill more
remarkable on this day. For, befides a pain which continu'd conftantly in
the whole belly, the fenfation of biting, as it were, recurr'd at times, in
every parr, but particularly in the epigaftrium. There was no pullating
pain, for. this I particularly afk'd, nor any puliation in any part. Nor was
the pain, which he felt in the fcrotum, or in the neighbouring part of the
belly, in thefe laft days, of any great moment.
However, when I felt the pulfe, I found that the fkin was really rough,
and dry, and yet not hotter than was to be expected. Having taken fome
food, he found himlelf a little better. He alfo faid that he had been re-
liev'd by the glyfter of oil , that had been given him the day before, and this
he had alfo faid, at the time of its being given. But on this day another
being thrown up, of broth in which the feeds of coriander had been boil'd
and iugar, he threw up the food he had taken while the glyfter came away.
In the evening he flept. Being afk'd after his fleep how he was, he an-
fwer'd that he felt a ftrange kind of pulfation in the epigaftrium, and that
there was fome fenfe of heat in the belly. In the mean while, he was
troubled with a vomiting of a more fluid matter, than he had been hereto-
fore, which was at intervals, alio, of a yellowifh colour. And this vomit-
ing
Letter XXXIV. Article 9. 131
ing continuing through the whole night, together with the reft of the fymp-
toms that I have mcniion'd, he expir'd In the morning, that is on the tenth
day of the difeafe.
The belly contain'd a great quantity of extravafated matter, of the fame
kind with that which had been thrown up by vomiting : and the ftomach, and
fmali inteftines, were very much diftended with the fame, quite to the hernia:
but in the whole of this irac"t, was no more than one worm, like the two
others which had been thrown up by vomiting. The large inteftines were
empty, white and found. The ftomach was alfo found. But the adjoin-
ing interline, which receives the biliary and pancreatic duel, was fo livid,
in confequence of inflammation in that part, that it had already a gangren.-
ous fmell. An inflammation more flight, and not yet livid, affected the je-
junum in feveral places, and the much greater part of the ileum. For t'le
remaining part, I mean that which lay moft contiguous to the colon, was
affected rather with a gangrene, than with an inflammation, as the deicrip-
tion of the hernia will fliow.
The facculus was of the form of a pear, and confifted of a coat, which
was not lefs thick, and firm, than the pulmonary artery. It was cover'd
not only by the fcrotum, and the dartos, but alfo by the cremafter muicle,
and with that membrane, upon which this mufcle lies, in common with the
teftis, and the veflels that go thereto. The teftis was under the iacculus,
and the veftels adhcr'd externally, on the internal fide, and went to the belly,
near to the orifice of the fac, but not through that orifice. This orifice was
like a pretty thick ring, which the peritonaeum, and the furrounding ten-
don, form'd: and it admitted, befides the inteftinum ileum, and a fmall pare
of the mefentery, which was annex'd to it, the omentum alfo, of which I,
for that reafon, had feen fcarcely any part covering the inteftines, on the left
fide, becaufe it was drawn towards the right fide, to the hernia : nor did it
only go down to the fundus of the fac, but forming itfelf into a round body,
which I fhould not have known to be made up of the comprefs'd fubftance,
of the omentum, if I had not cut into it, return'd up again from thence, and
connected itfelf to the intercepted ileum, not far from the orifice of the fac-
culus.
But whatever part of the omentum was contain'd in this facculus, I found
connected thereto, by a redifh kind of body, that was interpos'd, and was
flaccid in its fubftance, fo that it could eafily be feparated from the omen-
tum, and the facculus •, nor did it feem to be any thing elfe but mem-
branous cells, full of ferum and blood. The ileum, however, was neither
connected to the facculus, nor did it reach to the bottom of it; but curving
itfelf in the manner of an arch, a little below the orifice, it return'd into the
belly, by the fame way it had come down ; fo that if you difpos'd it re-
gularly, you would find that no more than four or five inches of the intef-
tine was intercepted. All this part was affected with a gangrene, and of a
black colour •, but ftill much more fo, where it was conftnng'd in the orifice
of the facculus : and the circumference of this orifice was no lefs black and
foetid, as the neighbouring upper part of the ileum was •, and this was even
fo tender, or rather rotten in its fubftance, that it could not fupport the
force of the humour, which diftended it, but being perforated with one
S 2 foramen
1 32 Book Ilf. Of Difeafes of the Belly.
foramen of a pretty confiderable fize, pour'd out its contents by that way,
into the cavity of the belly. Among the remaining vifcera of the belly,
which, as well as the inteftines, were as yet confiderably warm, notwith-
ftanding it was thirteen hours after death, before the body was open'd, the
liver had alfo contracted a difeafe •, for it was black on its edge, and on the
hollow furface, together with the gall-bladder, which was of a moderate fize,
fomewhat black.
In the thorax every thing was found, although in the right ventricle of
the heart, there was a polypous concretion, of a yellowifh colour, and foft •,
which extended its almoft-white appendages from thence, quite into the ju-
gular veins.
10. In regard to the many things that might be obferv'd here, fome I (hall
hint at more properly below, and others I mall touch upon, as foon as ever
I have given you another obfervation, which I took about four months after
the former, in the fame hofpital.
11. A woman of more than fifty years of age, who had already labour'd
under two hernia?, for the fpace of two and thirty years, both of which were
on the left fide, one at the navel, and the other at the pubes, having, by
chance, fallen from a place that was not very high, was not at all hurt by
her fall, except that (he receiv'd a contufion about the top of the fcapula
and the fhoulder bone. From this contufion (he eafily recover'd, but in the
mean while, began, at the interval of a few days after her fall, to have a very
great coftivenefs, and a little after to throw up, by vomiting, a yellowifh,
and fluid matter, which had exactly the fame fmell, as the excrements, dif-
charg'd from the rectum, generally have. The vomiting came on at dif-
ferent times, but more particularly two or three hours after food had been
taken in. The pulfe was neither frequent nor devoid of refiftance, when
prefs'd under the fingers •, it was extremely fmall, efpecially after vomiting,
:\nd grew lefs every day. As glyfters were of no ufe, mercury was given
twice, to the quantity of two drams, the firft time without any effect, but
the fecond time with fuch an effect, that the patient had three ftools, folid
excrements being difcharg'd the firft, and the fecond time, and the third
time fluid. Nor did it feem that this remedy had done any mifchief. Yet
the woman died about twelve hours after taking mercury the fecond time,
on the fourth, or fifth day, after the vomiting had begun, and half an hour-
after the time in which fhe had laft vomited ; whereas, through the whole
courfe of the difeafe, fhe had neither labour'd under any evident fever, nor
convullion, and had born the pains of her belly with fo little complaining,
that I have no remark made upon them.
When the abdomen was cut into, and its cavity laid open, a very ftroncr
fmell of putrefaction iffued forth. The inteflinum jejunum, and the neigh-
bouring part of the ileum, were univerfally diftended with the fame kind of
matter, which had been thrown up by vomiting. But the remaining part of the
ileum, and the large inteftines, were contracted. The jejunum being dif-
tinguifh'd, in fome places, with lines of a lively red, and in a longitudinal
direction, was in other parts of a brown colour, mix'd with red, as the ileum
was likewife, almoft in every part. But I found this laft-mention'd intef-
tine, not far from the jejunum, to be much more confiderably affected, to.
the
Letter XXXIV. Article 12. 13-
the extent of three or four inches-, which was the very part of it, that to-
gether with the annex*d mefentiy, went down into the facculus of the lower
hernias, curv'd into the form of an arch. For although this prolaps'd part
of the inteftine, was neither connected to the facculus, nor to the orifice of it,
which refembled a kind of ring, as it were, yet being feiz'd with a gangrene,
it was of a bloody colour inclining to black, and wept a bloody ferum from
its furface. However, no inteftine, but only a part of the omentum, en-
ter'd the upper hernia, which when look'd upon externally, was divided into
two little mountains, or rifings, as it were, and internally it was made up of
one fi\c, into which the peritonaeum had been extended.
As, befides the inteftines, we look'd over the other vifcera of the belly ;
for the thorax and the head were not open'd ; we obferv'd the liver to be iome-
what hard, the fpleen lax, and externally livid, but only in fome places.
The ligaments of the uterus were black : but the uterus itfelf was very
fmall, and its parietes were very thin. And thefe being cut into, the fub-
ftance of them appear'd to be lb livid in the middle, that it feem'd to be
inclin'd to a gangrenous Hate. As I had obferv'd the uterus to be feated a
little lower than ufual, it came into my mind to infpec~r. the vagina, that I
might fee how low the uterus had fallen down, into that cavity. And it
happen'd, that no fooner had I laid the labia afide, and difcover'd the orifice
of the vagina, but a certain body appear'd to be pufhing forwards, which at
firft any one might have taken for the os uteri. But as I had, juft before,
feen the uterus not to be in fo low a fituation, that if it were even extremely-
large, it could have reach'd thither-, I differed that and the vagina, imme-
diately after taking them out of the body, and found the glandular body of
the urethra to have become fo thick, and to have drawn the vagina, which
was in other refpects lax, and without any rugae, downwards in fuch a man-
ner, that the extremity of it, which is perforated to make an orifice for the
urethra, might eafily be taken for the os uteri falling downwards, and eafily
impofe upon a furgeon who was not well-experienc'd, not to mention that it
might eafily impofe upon a midwife.
12. But thefe laft circumftances relate to another fubject. Let us now
attend to what relates to the prefent. As to the woman's having fcarcely
complain'd of pains in the belly, and being without a fever, through the
whole of the difeafe, do you think that thefe circumftances can be accounted
for, from fuppofing the iliac paflionto have been produe'd in her, " by reafon
'* of the expulfive faculty being abolifh'd," as Salius fays (b) -, or by reafon
of " an atonia, orlofs oftenfion, from the nerves of the inteftines being ob-
" ftrucled," as the opinion of Ruyfch (c) is ? The former of thefe authors
fays, that fuch is the ftate of the cafe, " when attended with no pain -," and
the latter did not at all doubt, but for this reafon it was, that the ileos, in a.
certain woman, had been attended " with no remarkable pain or fever."
But not to enquire now, into what we lhall fee below (d), whether, when
the inteftines are in fuch a ftate, the feveral contents thereof can be thruft
back, and driven upwards, into the ftomach, fo as to be thrown up by
(i) C. cit. fupra ad n. i,
(c) Obf. anat. chir. 91.
00 N. 30.
vomiting,
134 Book III. Of Difeafes of the Belly.
vomiting ; and not to difcufs this point, whether the other figns of that con-
(litution, v/hich Salius enumerates, did really exift in the woman whom I
have defcrib'd, it is pall a doubt, that neither Salius, nor Ruyfch, fuppofe
an inflammation of the interlines to exift at that time •, for both of them
mention this feparately, and the firfl of them exprefly fuppofes, in cafe of in-
flammation " a fever, and together with it, violent pains, whereby the pa-
tients are violently excruciated." Is it poflible then, that there could be an
atonia in the inteflines of this woman, where it is manifeft there was, at the
fame time, an inflammation ? Be this as it will, it was certain that none of
the many caufes of this diforder, which Salius enumerates, had preceded.
But in regard to the queflion, whether a fever may fometimes be abfent
from an inflammation of the inteflines, I fhall have another opportunity of
determining that hereafter (e).
13. But now if we confider what are the confequences of inflammation, in
the two hiflories I have given you, it will be eafy to conceive, how much it
behoves every phyfician, whofe intention it is to prevent the progrels of this
difeafe, to admit of no delay ; and what remedies he ought to be fufpicious
'of, when the diforder has already made fome progrefs, leaden bullets, for
in fiance, and mercury. For if the inteflines, being rotten from fphacelation,
as in that young man, who was a hufbandman (f), do not refill even the
matter which they contain, we mud beware of increafing their contents, by
differing the patient to take in more than is abfolutely neceffary, and flill
more mud we be cautious, how we make him take in the mod ponderous
fubflances, which would open a paflage for themfelves, through the lubftancc
of the inteflines, inflead of opening the natural paflage, and by this means
accelerate death. And this happens much more eafily, where there is, at
the fame time, fuch a conflriction of the intefline, as fuffers nothing to pafs
through it, till the intefline is replac'd.
For the fame conflriction, by vitiating the intefline that lies immediately
above, renders it unequal to fupporting the diflention, and the weight •, and,
at the fame time, the matter which diflends, and loads it, is obflructed, in
that very place, where the intefline is mofl weak, and diieas'd. But yet
Hoffmann (g), you will fay, fav'd a woman in a volvulus, from the in-
tefline being intercepted in a bubonocele, by giving quickfilver to the
quantity of half a pound •, although thofe are not wanting who think thi«
cafe almofl incredible. To me, however, it feems the more credible, be-
caufe Alphonfus Khonius (h)had, long before, remov'd the fame diforder in
a man, from an intefline being intercepted in an ofcheocele, or fcrotal hernia,
by giving him nine ounces of quickfilver. But altho' the fymptoms, in both
cafes, were violent, yet the conflriction of the intefline might be lefs, and it
is certain the diforder had not yet proceeded to a fphacelus : as it is, likewife,
certain that this was not the cafe, in the great number of patients who, as
we read in feveral authors, were cur'd of a volvulus, by taking even a much
greater quantity of this metal.
In relpecl to thofe patients then3 in whom the inteflines are as yet firm,
and ftrong, I had never any fear of this kind ; for it firfl arofe from feeing the
(e) EpuL 35. n. 20. (?) Medic, rat. t. 4. p. 2. f. 2. c. 4. obf. 3.
(/") N. 9. ih) Eph. n. c. dec 3. a. 9. obf. 79.
flate
Letter XXXIV. Article 14. 135
itate of the inteflincs, in that hufbandman, when di fleeted, which put me on
fuppofing how much the inteftines might be weaken'd in others, alio, when
the difeale was much advanc'd. And I wonder'd, from that time, to this
very day, on which I revis'd this letter, that I had, to my knowledge, lit on
no writer in practical medicine, who, when he fpoke of this remedy, againrt
the difeale in quefcion, as moil of them have done, gave us the lead warn-
ing of this probable danger, befides one whofe opulculum (i) I have lately
read, I mean that eminent phyficiun Mead, who very ferioufly admonifhes
us, " that we ought not to delay long" the ufe of quickfilver, in the ileos,
if other remedies are of no advantage, '■ becaufe it is to be fear'd, left a
" gangrene mould faceted the inflammation, as frequently happens, by
" which the coats of the intefline, being corrupted, fufFer the ponderous.
" metal to efcape through them, into the abdomen."
Nor do I fuppole that you would think of objecting to this caution, the-
obfervation of the celebrated Wahrendorff (k), which relates to the hiftory
of a patient with an iliac paflfion, in whom half a pound of quickfilver,,
which had been given, had rcach'd quite to the colon, and had not burft
through the corrupted ftomach, or the duodenum, which was affected with,
a fphacelus. For as the patient died " three days after " he had taken the
mercury, you eafily perceive, that in this fpace of time, the inflammation, which,
was ftill in thejejunum, and the ileum, might have degenerated, in the duode-
num, and Itomach, into a fphacelus, which did not exift before. And I fup-
pofe you would make ufe of much the fame kind of anfwer, if any one
fhould object the obfervation of Schroekius (/), who in a patient that died of an
obftinate obftruftion of the bowels, found about two pounds of quickfilver, at
the beginning, and termination, of the inteftinum ileum, and faw it adhering to
the coats of this intefline divided into very minute particles, without thefe
coats having been perforated thereby, notwithftanding the inteftines were
not infiam'd indeed, but fo extremely weak, that, being handled a little
roughly, they were burft through "infeveral places." For there were mere
than twenty days betwixt the lail time of taking the mercury, and the pa-
tient's death, fo that the inteftines being diftended with air, and with faeces,
they might, at length, become corrupted, in the latter part of the time •, nor
is it certain whether they were, in fact, thus rotten in thofe places, alfo, in
which the quickfilver had ftagnated.
1 4. You will perhaps afk, why in the patients whom I have defcrib'd, the
intefline was not replac'd ? And why, as it was not replac'd, a part of the
contents, neverthelefs, efcap'd from the fmall, to the large inteftines, in fome
of the cafes. In regard to the firft enquiry, fuppofe that fome were brought
into the hofpital, much later in the difeale than to admit of this operation,
that others were brought in early enough, but at that time, when fcarcely any
of the furgeons, in the greater part of the cities in Italy, were daring enough
to make ufe of the knife, in order to lay open the narrow paffages, which
prevented the inteftines from being replac'd, by any other means.
In regard to the part of the matter contain'd in the inteftines having pafs'd
(/') Monita medica c. 7. f. 2. (/) Eorund. dec. 3. a. 5 & 6 obf. 299.
(i) Ait. n. c. t. 3. obf. 131. ante Ha.
5 through
136 Book III. Of Difeafes of the Belly.
through thefe narrow pafiages, in fome patients, I would firfc have you obfervc,
that the faeces, which I have faid was difcharg'd by means of glyfters (;«),
had been below the place of conftridtion, before the inteftine was conftring'd ;
and that it may happen in volvulous patients, not only by the afiiftance of
art, but by the help of nature, that the contents of the inteftines, which are
below that part, may be difcharg'd, Salius (n) has confirm'd, in oppofition
to the common doctrine at that time, not only by reafon, and his own ex-
perience, but by the experience of Hippocrates (0) alfo, in the woman who lay
ill at the houfe of Tiiamenus, except that he aflferts this to happen, while
the difeafe is coming on, and not when it is already form'd.
But in the woman whom I have defcrib'd (p), it is evident that this hap-
pen'd near the clofe of a mortal difeafe, and that not only the contain'd
matter which was below the conftricted inteftine, had been, more than once,
difcharg'd by (tool, but finally, perhaps, even a part of that which lay above
the conftnetion, and efpecially the mercury •, unlefs you mould fuppofe that
this remedy given in its fimple (late, in a very fmall dole, and without any
purging medicine being join'd with it, had a power of propagating I know
not what irritation through the intercepted parietes of the mteftine, which
were not yet feiz'd with a fphacelus indeed, but were affected with a gan-
grene. Yet as this is not eafy to fuppofe, it will feem very probable, that
the inteftine was lefs clofely conftricted in this woman, than in the young
hufbandman (q), fo that the weight of the mercury, aflifted by the change
of fituation in the body, by the agitation of vomiting, and by the prefllire
upon it, might have been able to pafs through that fhort tract of the intef-
tine, and after that, by the help of the found inteftines, promote the dif-
charge of the matter which was contain'd below the conftricVion. But I will
now give you one of thofe examples, in which the inteftines did not ceafe to
make fome little difcharge, through the whole courfe of the difeafe.
15. Mary, the wife of Antony Francifcati, a carman at Padua (for the
very extraordinary number of valves, that I found in the pulmonary artery
of this woman, made me enquire, very particularly, into her name, and
other circumftances relating to her) aged thirty-nine years, of a moderately
good habit of body, not a bad colour, and much lefs of an icteric com-
plexion, having had many children, the laft of which fne had given fuck to
for fix months, when fhe was feiz'd with this fatal difeafe, and having been
fubject to no other, except a little femoral hernia, from which this laft dif-
order, at length, had its origin, and which fhe, having been accuftom'd to
replace of herfelf, whatever part it was that fell down from the belly, had
attempted to replace now, likewife, for feveral days together, but not being
able to fucceed, was feiz'd with a fever and vomiting, and the other fymptoms
which generally attend this diforder, except that fhe could always make fome
little difcharge by ftool. She was at length brought into this hofpital, much
later'than fhe ought to have been, where, though to all appearance fhe was
like a perfon who was about to die very foon, fhe neverthelefs drag'd on her
HN.9. (/) N. u.
.(») C. cit. fupra ad n. 1. (j) N. 9.
(e) -Epidem. 1. 3. f. 2.
3 lifcj
Letter XXXIV. Article 15. 137
life, for many days together, and even on the lad of them, feem'd to befomc-
what better, and to be eas'd by the glyfters which were thrown up, till, at
length, on the twentieth day or November, in the year 1704, flie died.
The belly being open'd the day afterwards, and the hernial facculus, at
the fame time, laid bare, which was thick, and eafily divifible, into many
laminae of coats, as it were, it was obferv'd to be quite disjoin'd from the
ligamentum teres of the uterus, but connected to the crural vefiels, to which
it lay contiguous, on the internal fide: nor had it a narrow orifice ; but all
the confinement which the hernia lufTer'd, was owing to the lower border of
the external oblique mufcle of the abdomen, that lay upon it, which border
is call'd the ligament of Poupart, or, rather, the ligament of Fallopius j
whereas it is in fact only the tendon of that mufcle (r) ; in which opinion
very fkilful men agree with me, and amongft thefe Heifter (j), and if you
read him attentively, Platner alio (/). Under this border then, was inter-
cepted fome part of the neighbouring inteftinum colon, yet in fuch a manner,
that a paffage remain'd fufriciently open through it, only the paries thereof
•was fhut up, which had lain in contadf. with the orifice of the facculus. This
paries, cohering with the facculus, was black and corrupted ; and the neareft
part of the inteiline, which lay without the facculus, was green.
The internal parietes and the belly were green alfo, and fmell'd very ftrong
in moft places. Yet in the vifcera of this cavity, I remark'd no morbid ap-
pearances, except in the gall-bladder, which was fomewhat larger than it
ought to be, and with a bile, that was not of a black colour, contain'd fix-
teen calculi, which fcarcely differ'd from each other, in magnitude, being
all of them fmall indeed, but not very fmall, externally yellow, and made
up of many fmooth furfaces. And having apply'd one of thefe calculi to the
flame, in the moifl ftate, in which it then was, I faw that it burn'd, not
without fparkling, and melted, but that it did not cherifh and prefervc
the flame.
As we difTected the remaining part of the body, on the fame day, and
on the following days ; for the other vifcera were very proper for demonftra-
tion, and the mufcles were extremely red -, nothing offer'd itfelf to our ob-
fervation, in any other part, which can be fuppos'd to relate to the prefent
fubject, except that in the medullary fubftance of the brain, were a great
number of bloody points, and a great quantity of blood, which gave rife to
thefe, as both the vense cavae, and the veins that flow into them, and efpe-
cially the vena azygos being diftended therewith, fignify'd ; and the whole
left lobe of the lungs was, on one fide, connected to the pleura, and on the
other, to the mediaftinum, and, finally, the thyroid gland was fomewhat
thicker than it naturally is : although many other circumftances occur'd which
are not unworthy of being notie'd in another place. One of which I will
not pafs over at prefent, as it had never before occur'd to me, nor had I ever
heard, or read, that it had been feen by any one, nor did I even hear after-
wards, from very learned foreigners, who came with great politenefs to vifit
me. And this was the realbn, why, in pointing out fome of my obfervati-
(;■) Adverf. anat. 3. animad. 1. (/) Inflit. chit, §. -jg}.
(/) Compend. anat. not. 4.
Vol. II. T ons,
138 Book III. Of Difeafcs of the Belly.
ens, to the celebrated Morand (a), in as few words as poffible, as my cufc
torn is, and particularly pafling over the reft, as they had been made by
others, as well as by me, I excepted this one.
That is to fay, in a woman, who had been fubject to no drforder, which
related particularly to the circulation, and had reach'd to the age which I have
mention'd above; and in whom, every minute part of the heart, and the
adjoining veffels, being accurately examin'd by me, fhow'd no difeas'd ap-
pearance whatever, nor any thing preternatural, I found at the orifice of the
pulmonary artery, inftead of three valves, four valves, and demonftrated
them to a crowded circle of learned men, and of ftudents who were prelent,
being fimilar, in their appearance, to thofe that are generally found there,
except that one was in every dimenfion confiderably larger than ufual, as
when you come hither, you mail, fome time, or other, fee; for I flill keep
them preferv'd in a proper liquor : and this was feated anteriorly, and towards
the left fide, in refpect to the others. But when I revis'd this letter, I was
pleas'd at my having faid above, that this was a very rare obfervation, in-
deed, but not that it was the only one. For, at length, among that great
number, and variety, of obfervations, which are publifh'd by the celebrated
Jo. Zacharias Petfche (#), as being taken in concert with his preceptor Caf-
iebomius, I lit on one of another woman, in whom " the pulmonary
" artery had four valves, that is to fay, three large ones, but the fourth
" a lefs." We alfo read that the aorta, of this woman, had fent off no
more than two branches upwards; but how many years ine liv'd, what
health fhe enjoy'd, and of what difeafe fhe died, is not added.
16. But leaving an appearance which, any where elfe but in the heart,
where nature is generally found to be fo fimilar to herfelf, would not have
deferv'd any great attention, I return to the confideration of the hernia, which
though very fmall, was neverthelefs fatal. And, indeed, in proportion as
herniae are neglected by patients, on account of their fmallnefs, fo much the
more dangerous do they often, at length, become, as that was, the facculus
of which " would fcarcely admit the extremity of the fore ringer (y)." For
the inteftine is more eafily conglutinated with a fmall facculus, and more
clofely conftring'd thereby. And to this muft be added, the filence of the
patients upon this head,, by reafon of the neglected fmallnefs of the hernia,
even when they begin to be tortured with pains of the belly ; fo that the ce-
lebrated Werlhof(z) prudently admonifb.es all medical practitioners, " not to
omit, in all colic diforders, to inquire into hernia?, which are often evert
very fmall, and overlook'd by the patients themielves, or conceal'd through
lhame;" and he relates, that to him, at leaft, it had happen'd more than
once, that notwithftanding he had made the inquiry again, and again, the
patients denied it, almoft quite to the laft.
It happen'd to me, alfo, in the cafe of a young man, who was equally
learned, noble, and pious, and who is now a very eminent man, that -when
by other phyficians, and by me likewife, it was much inquir'd, what could be
(u) Hilt, de l'Acad. r. des fc. a. 1741. obf. (y) Vid. aft. lipf. fuppl. t. 1. f. 12. in relat.
anat. 7. libelli launay.
(.v) DifTert. qua Sylloge anat. obf. &c §. (zj Commera littr. a. 1735, hebd. ,« n* 3*
47-
the
it
:<.
Letter XXXIV. Article 16. 139
the caufe of pains in the belly, that return'd every now and then, and the
more we inquir'd, the lei's were we likely to find it out; it happen'd, I fay,
that from this very abfenceof all other caufes, I fufpected the prcfence of that
caufe whereof we now fpeak. And that this l'ufpicion was not groundlels, I
found out by inquiring whether he rectiv'd any advantage from a lupine fili-
ation of body. For as the patient anfwcr'd in the affirmative, and as a little
tumour was l'oon after found which he himfelf, by reafon of its fmallnefs, had
not in the leaftobferv'd, the inteftine was replac'd foon after, and kept up by a
proper bandage, io that the pains return'd no more. But thefe pains had been
rather troublelome, than violent. And that colic pains, as I had begun to
obferve, are often brought on by hernia.', is not only fhown by frequent ex-
perience, but confirm'd by the diflection of a woman, given by the cele-
brated Weiffius (a), who had been often troubled with colic pains, on account
of a hernia, in the fame place, where 1 have laid our patient had one, and not
only containing a portion of the colon, but a portion of the ileum, and
omentum alio •, the gall-bladder being, likewife, loaded with a greater num-
ber of calculi, than it was in the woman defcrib'd by me.
The hernia of this woman may be call'd rare, as Littre fays (£), if it be
compar'd with thofe very frequent hernias, that are made up of the fmall in-
terlines. He defcribes one, in a noble-woman, fimilar to this of ours, whe-
ther you confider what he found in diffe&ing the dead body, or the power of
difcharging fome excrements, which he hadobferv'd in the living body. On-
ly the feat of it was higher. Another is taken notice of by Palfin (t), who
feems not to have read that of Littre, I fay that of the year 1714. But he
had read the obfervation of Hildanus (d)t which, when the author himfelf had
accurately coniider'd it, he had explain'd in the fame manner as Littre (e) :
and I even find that Bienailius had thus explain'd another, which he met
with at Paris alfo, in the year 1 671, as J. H. Lavaterus, who was prefent, pub-
lifh'd in the following year (f). For the reafon why a female patient, la-
bouring under a bubonocele, " had difcharg'd liquid excrements from the
" inteitines, through the whole time of the compreffion (quite to the feventh
*' day) was found by the operator," fays he, by whom he means the gentle-
man I juft now mention'd, " to be, that the inteftine was, in part only, con-
" ftricted."
But I have even remark'd of Ballonius, when faying (g), " that when the
tc apophyfis of the inteftinum cascum is prolaps'd into the groin," notwith-
Itanding it may become putrid, " it is not neceffary that thofe fymptoms
" mould, of courfe, follow, which are generally the confequences, in a fimi-
" lar affection of the other inteftines, whether fmall, or large " I have re-
mark'd, I fay, that when he fays thefe things, he has pretty clearly hinted
that if a prolaps'd part, either of the fmall, or of the large inteftines, fimi-
lar to that appendix, be intercepted in a hernia, the patient may have fome
difcharges by ftool, contrary to what happens when the whole tube of any
inteftine is intercepted. And it is certain that there are fome other appen-
(a) Commerc. cit. a. 1745. hebd. 24. n. 1. (e) Cent. 6. in obf. 71.
(b) Mem. de l'Acad. r. des fc. a. 1714. (f) Diff. de inteftinor. compreff. thef. 6.
\c) Anat. du corps hum. tr. 1. ch. 8. (g) L. 1. confil. med. 103.
(^) Cent. 1. obf. chir. 55.
T 2 dages
140 Book III. Of Difeafes of the Belly.
dages now and then, befides that natural one, which are alfo call'd diverti-
cula, and that they enter the hernical facculus, whether they are gradually and
preternaturally produc'd, or are given to fome bodies from their firft origin.
For I would have you be cautious of fuppofing that they are all preternatu-
ral, and efpecially that they were all form'd from the fide of the interline
being prolaps'd into the hernial facculus ; for fometimes, as will be faid be-
low (£), they belong to thofe inteftines which are not fituated in the places
where herniae happen.
Wherefore, you will, without doubt, be of opinion with Littre (/), and
Mery (£), that thofe appendages, which they faw, were form'd in that man-
ner, or at leaft increas'd : and if you alfo choofe to fuppofe, that thofe three
which were feen by Schrockius (/), in a young man, who had been often
troubled with pains in his belly, but not from hernise, which were no
where found, took their origin, or increafe, from fome morbid caufe, I mall,
perhaps, not very violently oppofe your opinion. But if you mould affert
that fome others, as, for inftance, that which is defcrib'd by Weitbrecht(w),
in a woman, which was furnifh'd with confpicuous fibres, in the fame man-
ner as the other inteftines, did not exift from the firft formation of the body,
I certainly (hall not be able to affent to your affertion.
For I do not doubt but this was of the fame kind with that which I found
in an old woman, inafmuch as that had the fame fubftance, and thicknefs, of
parietes, with the other inteftines, and hung perpendicularly from the ileum,
where it was nearer to the colon, than to the jejunum : and this I would have
you add to my very fhortdefcription in the Adverfaria (»), fince Hunauld (0),
when defcribing another which had been feen by him, has defir'd that this
mould not be pafs'd over. And perhaps that was nearly of the fame kind,
which I faw in the woolcomber (/>), though it differ'd from the former in
thefe circumftances, that it was fhorter, and hemifpherical, in its figure, and
plac'd contrary to the infertion of the mefentery, where the ileum was fo re-
flected, as to make an angle, which continu'd even when the mefentery was
cut off-, for in that the very prominence of the angle was protuberant, much
in the fame manner, if you confider the fituation only, as that which is deli-
neated by Ruyfch, in the Mufaeum Anatomicum (q). Thofe which I have
feen befides, I have not a defcription of, and indeed have feen but very few,
though I have examin'd the inteftines of fo many bodies.
17. And from hence it is, that the more I confider, the more I fuppofe thajr
the words of Ruyfch, in the feventh Thefaurus (r), " diverticula of this kind
" are generally, if not always, to be met with in the ileum," are to be taken
in a different fenfe from what they feem at firft to convey •, I mean, in fact,
that when they are really found, they are generally found in this interline.
At leail in this inteftine they have been feen, by thofe who are mention'd by
(b) N. 17. (0) Hift. de Pacad. r. des fc. a. 1732. obf.
(/') Mem. del'acad, r. des fc. a. 1700. anat. 2.
{k) Mem. a. 1701. obf. 1. (p) De quo epift. 36. n. 22.
(/) Eph. n. c. cent. 8. cbf. 50. (y) Fig. 3. ad thee. c. repof. 3. n. II.
(w) Comment, acad. imp. petropol. t. 4. (r) N. XV". 3.
(n) III. animad. 5.
Letter XXXIV. Article 17. 141
me at prefent, or have been mention'd before (s), and befides theft by Hcn-
ricus Meibomius (/) formerly, and niter that by others, and among the reft
by thole very experienced men, Waltherus (»), Schlitingius (x), and lately
by the celebrated Bcnazoli (y) ; to fay but little of myfelf, who neverthekl ,
not to omit this circumftance that relates to my own obfervations, very
well remember that the bodies, in which I faw theft appearances, had not
been thole of maniacal perfons, nor do I ever remember to have feen them,
in the bodies of maniacs, that I have happen'd to difiect. I have alfo feen
the fame appearance, more than once, in geefe, and particularly in one of
fuch a breadth, that it could not be taken for the remains of thatdudt, which
had formerly belonged to the vitellum. And in thefe creatures, likewife, it
communicated with that inteftinc, which anfwers to the ileum, and even
with the part of it, that is neareft to the large inteftine ; which I fee has
happen'd in the human body, both to me, and to others, who have ex-
prefsly told us, to what part of the ileum, they were connected.
From hence a confirmation may be taken, of the caufe pointed out by
the celebrated Fabricius (2), why morbid appendages happen chiefly in the
ileum. For if the inteftinal contents, which defcend to the ileum, from the
parts above, by reafon of the greateft part of the chyle being already taken
up into the ladieal vefTels, begin to acquire fo " very thick a confidence," as
to urge the thin coats, and diftend them; this confidence will certainly be
thicker and thicker, the greater progrefs thefe contents fhall have made,,
through the ileum, as, by this means, they will have parted with itill more
chyle, or any other fluid that was mix'd with them. Wherefore the diverti-
culum, alfo, which he faw, was. not more than two fpans diftant from the
extremity of the ileum. What then, you will perhaps fay, are we to under-
ftand Ruyfch fo as to fuppofe, that thefe diverticula are fometimes to be met
with in other inteftines, in like manner ? Without doubt : for when I read
over my obfervations, I cannot help believing that it happen'd to him, fome-
times, much as it happen'd to me, when I faw an appearance of this kind,,
once in the reclum, and again in the duodenum. This appearance in the
reclum, I have defcrib'd in the Adverfaria (a) ; and it was in the body of
an apople&ic man, that I faw a diverticulum connected to the duodenum,,
almoft two inches below the pylorus, which was a kind of cellule not very
protuberating, but big enough, in its orifice, to admit a finger, furrounded
with no coat, but the external one of the inteftine, yet having not the leaft
traces of any prefent, or pall:, ulceration in that part, as indeed there were
not in the ftomach, or the whole inteftinal tube.
But as thefe diverticula, when they do exift, are chiefly to be met with in
the ileum, as I have faid, which is the longeft of all the inteftines, and plac'd
in that part where hernias. do moft frequently happen, it is not to be wondered
at, if they enter into hernias chiefly from the ileum.
And then Ruyfch thought it might happen that no fymptoms of a hernia
fliould follow (b). And Littre (c) had, before, exprefsly taught, that all the.
(/) Adverf. III. animad. 5. (z) Progr. helnnladt. editumjanu. 1750.
(/) Epift. de vaf. palpebr. (a) Animad. cit. 5. in fin.
(u) Prcgr. de aneur. (/;) N» 3. cit.
(a-) A&. n. c. t. 6. obf. 20. (c) Mem. de l'aead. r. des fc. a. 170c-
(y) Comraent. de boncn. fc. acad. t. 2. p-
1. iiuer analon) .
5 fymptoms'.
742 Book III. Of Difeafes of the Belly.
fypmtoms of hernias, of this kind, proceed more flowly, and are lefs violent,
than in other hernias, where the whole tube of the inteftine is ftrangulated,
and that they are particularly diftinguifh'd by this circumftance, that a dif-
charge of the fasces is never impeded. And he adds other things, in which
are thefe alio, that the abdomen is neither tumid, nor tenfe, nor fill'd with
flatus, as in common hernias. Which circumftances, although they feem
to be agreeable to reafon, on account of the pafiage through the inteftines
being then free, and are very properly confirm'd, by the approbation of Pal-
fin (a), and of others, are neverthelefs not always to be depended upon, as
indeed no maxim, whatever, in medicine is fo well fettled, but it may fome-
times miflead \is •, and in order to evince this, I will, here, add an obferva-
tion of my own, which I have indeed, already, juft hinted at in the Adver-
faria (e), but not wholly defcrib'd ; for from this it will appear, how very
different the cafe was with a patient, in whofe hernia a part of the inteftine
was fo intercepted, as ft 111 to have an open pafiage left through it.
1 8. A porter of Bologna, who was fo far broken down by continual la-
bours, and fatigues, that when he was in his fiftieth year, he appear'd much
older, had a hernia in his right groin, of the bignefs of a man's thumb,
which fometimes feem'd to be remov'd. This man, about the middle of
March, in the year 1706, without any previous caufe, except perhaps that
a fnowy day had come on, all of a fudden, after very temperate weather, was
feiz'd with a pain of the belly, which was vague indeed, but very fevere, and,
as his own exprefllon was, juft as if he were gnaw'd by dogs. And this
pain, although it feem'd to have grown much milder, by applying I know
not what kind of ointment to the belly, yet foon after grew more violent
than ever, and was never afterwards diminifh'd. As the man was brought
into the hofpital of St. Mary de Morte at Bologna, when the difeafe had al-
ready continu'd fix days, his flefh was almoft cold, his pulfe was very
frequent, but ftill fmall, and gave little refiftance to the fingers which
prels'd it, and ftruck them with an unequal force of percuftions, his whole
abdomen being diftended like a drum, but more below the right hypochon-
drium, where fome cells as it were of the inteftinum colon feem'd to be felt
with the hand, and the hernia being become much harden'd in its fubftance,
although he denied that this was the principal feat of the pain. He threw
up his food. For four days he had difcharg'd no fasces at all, from his in-
teftines. It was even in vain that he endeavour'd to difcharge the flatus it-
felf.
Frefh drawn oil of almonds was given him ; and linfeed oil thrown up by
way of glyfter to the quantity of ten ounces. The latter return'd juft as it
went up, and the former he threw up from his ftomach, and complain'd that
'he was difturb'd, and agitated thereby. Being afk'd what tafte he had in his
mouth, he anfwer'd that of poifon. He was very thirfty. His vomiting con-
tinu'd. On each of the following days, that is on the feventh, and the eighth,
a glyfter was thrown up, the firft compounded of the benedifla laxativa and
other ingredients, and the fecond of milk and the white of an egg ; but they
were of no more ufe than the former. As no excrement at all was dil-
f.'f) C. cit. fupra ad n. 17. («) Animad. ibid. cit.
5 charg'd,
Letter XXXIV. Article 18. 143
charg'd, and the other fymptoms, which I have dti'crib'd, continu'd, and the
pulfe, although after the fixth clay it was no more unequal, became more
weak, and fmaller, lb that on the ninth day we could hardly feel it at all, and
as the fkin was now corrugated, the body cold, and the patient unable to lift
up his eye-lids, and almoft to Ipe.ik, notwithstanding he beg'd for wine, he
lank by degrees, and, at length, on the night following, died in a very pla-
cid manner.
The body,, which had a fqualid appearance, the Akin being rigid and not
without fome fcabies, I di fleeted on the following night. When the abdo-
men was open'd, a fmell came forth like that which generally proceeds from
gangrenous parts. The omentum was extended quite into the hernia, and
entirely red from inflammation, except fome broad lines, as it were, which
were drawn in a tranfverfe direction. The fpleen was, in fome part of it,
infected with a morbid livor, which was alfo carried to the internal part, al-
though to a very inconfiderable depth. The ftomach ftretch'd itfelf much
more to die right fide, than it ufually does, being univerfally diftended with
a yellowifh matter, that refembled nothing more, than a fluid excrement,
with which the fmall inteftines, from the ftomach quite to the hernia, were
alfo diftended, to a very great degree. For whatever us'd to be carried from
the ileum to the large inteftines, remain'd there, and was collected in great
quantity ; and the large inteftines were all very much contracted, and white,
fo as to make it manifeft, that nothing had pafs'd through this part of the
ileum which belong'd to the hernia; although the tube of the inteftine, it-
felf, did not enter the orifice of the facculus, but pafTing by the fide of it,
fent no other part of itfelf into that cavity, but a portion of its paries, relax'd
into the form of a femioval cavity.
The largeft axis of this cavity, where it began gradually from the inteftine
was about three inches, according to the length of the inteftine •, and the leaft
axis was much fhorter, inafmuch as it extended itfelf through the anterior
furface of the inteftine, at the interval of a fmall inch from the infertion of
the mefentery, to the inferior furface. From thefe beginnings, the cavity-
was more and more contracted by degrees, as the femioval figure requires, till
it defcended to the depth of a large inch in the middle. This part there-
fore, whether you choofe rather to call it a cavity, or a diverticulum, was
the only part of the inteftine, intercepted by the hernia, together with the
extreme part of the omentum, which was included with it, fo that the re-
mainder of the inteftinal tube was not at all comprefs'd thereby. But neither
of thefe parts could be drawn up from the hernia, as they were not only
confin'd by the nervous orifice, as it were, of the facculus, but even con-
nected to the facculus, by a kind of fibrous junction, that was not verj'
ftrong, indeed, but very frequent •, and the facculus, in the part where thefe
connections were, was fomewhat rough, but in other parts fmooth. Thrs
facculus was made up of the peritonaeum, relax'd towards the external fur-
face of the body, and carry'd out near the external fide of the fpermatic vef-
fels : and on one fide, and on the other, of the hernia, were two tumid inguinal
glands, one of which being very near to the facculus, had its fubftance in-
part white. The inteftine, in that part which was neareft to the facculus, and
ftill more the diverticulum of that inteftine, was of a red colour degenerat-
ing
r44 Book III. Of Difeafes of the Belly.
ing into black. And the inteftine from thence upwards (for below, as I have
faid, it was white, for a confiderable extent) was of a red colour, inclining
to livid : but the whole of the tube, from this trad quite to the ftomach,
was quite red, by reafon of the great number of blood vefTels, which were
crowded together in molt places. And the mefentery was of the fame co-
lour.
1 chofe alfo to open the thorax. The lungs adher'd every where, except
on the right, and arterior furface, to the pleura, and particularly at the fides,
and back, where this membrane v/as much thicken'd, but no where more,
than at the upper part of the thorax, on the right fide, where the fubftance
of the lungs was extremely hard, as if from an old difeafe ; and in the inferior
part, and on the right fide, likewife, it was confiderably more compact than
it generally is. However, the lungs abounded with moifture, almoft in
every part.
In the pericardium was no water, but the heart was flaccid, and contain'd
polypous concretions, in each of its orifices, as it did in the right ventricle
alfo, and the left auricle, all of them being moderately condens'd, and molt
of them of a fmall fize : for that was the imalleft which lay in this auricle ;
and that was the longeft which reach'd into the pulmonary artery, and its
branches.
19. I do not doubt but you will naturally enquire of me, why, notwith-
ftanding the paflage remain'd open through the inteftine ileum, yet nothing
pafs'd through it. I confefs I can fufpect many caufes, but can affirm none
for certain. The inteftine was, in that part, exceedingly injur'd by inflam-
mation, and at the fame time irritated, on account of a portion of itfelf hav-
ing fufrer'd diffraction, and interception. Did the periftaltic motion, there-
fore, by which the concents were pufh'd on, ceafe in that place ? Or was
there fome convulfion, by which, that part of the tube was contracted, in
the living^ more than in the dead body ? Or finally, did inflammation caufe
this contraction, by rendering the vefTels, and the parietes, more turgid,
while life remain'd, which after death were relax'd ? At leaft Littre (/) hints
at ibmething, which relates to this third caufe, when he conjectures why by
that noble woman, whole hernia took in a portion of the colon, fometimes
frequent, and large, difcharges were made from the inteftines, and at other
times lefs large and lefs frequent. Nor would I have you make it an objection,
that in this woman, although the inteftine w. ; inflam'd, and a portion of
it intercepted, more or lefs of the contain'd matter could always be carried
through it, as in that woman, alio, whofe hiflory I gave you under number
fifteen.
For to omit, that in different perfons there may be a different degree of
injury, a different degree of power, in the inteftines, and a different degree
of fenfibility •, it is certain that in thefe women the queftion is of the colon,
and in this man of the ileum, which, not to inquire whether it has more
acute fenfations, is at leaft more narrow, in many parts, than the colon •, fo
that if even a larger portion, according to the breadth, of the latter than of the
former, be intercepted, a more open paffage will remain in the colon, and
C/J ViJ. fupra n. 16.
a larger
Letter XXXIV. Article 19. 145
a larger extenfion of the parietcs, in which the power of pufliing forwards
the contents confills, and with thefe alfo will remain thofe three ligaments,
that is to lay, thofe three mufcular bands, which it is fo much the lei's pro-
bable mould be intercepted within herniae of this kind, as it is the more dif-
ficult for the paries of the colon to be relaxed, in a part where it is fortified
externally with one of them : and this external fituation, and more compact
fubftance of the fafciae, or bands, may alio have this effect j to prevent
them from contracting a diforder fo eafily. And from thefe confiderations
you will perceive, not only why the diagnofis of herniae of this kind, pro-
pos'd by J.ittre, may anfwer much better in the colon than in the ileum ;
but alfo why it will anfwer better in the ileum itfelf, where the orifice of the
diverticulum is pretty narrow, fuch as it is defcrib'd (g) by the fame author,
not when it is fo large as my defcription fhows it to have been in the porter.
I fay anfwer better •, for I dare not .take upon me to fay that where the orifice
is thus narrow it will always, nevertheless, anfwer.
And thefe things you know I had written to you, when I receiv'd a
book that was lent to me by the celebrated Benevoli (A), wherein he de-
fences in the fecond place, a hernia made up, as was confirm'd by the de-
fection of the body, of an appendix of the ileum, extending itfelf into the
fcrotum. Which, although it communicated with this inteitine, by an
orifice that, in the dead body, was not larger than to equal the diameter of a
fmall filbert •, yet the patient had, for the firfl fifteen days of the difeafe,
which was very violent, thrown up every thing he took in, by vomiting, and
dilcharg'd nothing by (tool, and had thrown up, very early in the difeafe, a
matter like the fasces. Befides, the inteftinum ileum, in the part which cor-
refponded to the hernia, was, for fome confiderable length, of a colour that
was not quite natural, and was very much corrugated and contracted ; from
whence it was eafy to conjecture, that the inteitine, being violently drawn
down by the diftended, and inflam'd, appendix, was, from this caufe, at-
tacked with inflammation, deprefs'd, andconvuis'd.
I would have you join this hiftory with the hiftory that I have given of
the porter; and the conjectures which depend upon what was remark'd in the
direction, I would have you join to thofe things which I fufpected, in regard to
the caufes why the diagnofis of herniae, of this kind, which is given by
Littre, may fometimes not anfwer. But if not only the appendix, but the
ileum itfelf alio, be intercepted within the hernia, and vitiated by an in-
flammation, and gangrene, as in the observation of Mery (i) ; it is evident
that a difcharge by {tool is then prevented, and that the other ciraunftances
happen, which are wont to happen m affections of the ileum of that kind :
are wont, I fay; for although thefe things happen to moil patients in this
cafe, there are fome, in whom neither the bowels are quite lock'U up, nor
are there vomitings of the excrements, or matter fimilar thereto, as, for in-
stance, in thofe whom the celebrated men Wolf (k), and Cohaufen (/}, have
defcrib'd-, fo that there is lefs.reafon to be furpriz'd, that it did not happen
/gj Mem. del' a. 1700. ,{k) Aft. p. c. torn. 4. obf. 68.
(■':) DueRelaz. chirurg. (/) Commcrc. litter, a. 17+2* hebd. 26. n.
U) Cit. fupra ad n. 16. II. ad. 3.
Vol. II. U • other-
146 Book III. Of Difeafes of the Belly.
otherwife, to thofe vvhofe difeafes and directions are related by the cele-
brated Scorch (m), and Bajerus (»), whereas a part of the colon was inter-
cepted in the hernia, and not of the ileum, which however was, univerfally,
together with a large tract of the ileum, affected with that inflammation,
from which the colon was free.
20. Having thus produc'd, and pointed out, the obfervations in which the
pains of the inteftines arofe from a caufe that fell under the notice of the
eye, I go on to thofe in which the caufe lay entirely hid within the body.
And I will begin with thofe, that, by reafon of the vomiting, and inflamma-
tion, come nearer to thefe which I have already defcrib'd. The two firft are
from the papers of Valfalva.
21. A {lender man, of fifty years of age, began, after many fatigues in
hunting, to complain of a great heat at his throat and cheft. This heat, de-
ferring thofe parts, difcover'd itfelf in the loins, and in the belly, in like
manner, where being join'd with a punctorious pain, it fo troubled the pa-
tient, that he could not bear the parts to be touch'd. On the firft days the
man was frequently feiz'd with a cold rigor. But five or fix days before
death, a volvulus came on, with a throwing up of the fseces by vomiting :
and this, by gradually wearing out the ftrength of the patient, brought him
to the final clofe of life, about the thirtieth day after being confin'd to his
bed.
The belly was found to be univerfally fill'd with fanies, which had con-
nected the omentum, and the inteftines, to each other. The left kidney
contain'd extravafated blood, under the internal membrane, but not in
every part. In the omentum, and on the edge of the mefentery, particu-
larly where it was connected with the colon, were obferv'd many fmall ab-
fcefles and ulcers.
22. When the abfcefTes firft began to be form'd, not only the belly was af-
fected with difagreeable fymptoms, but the loins alfo, to which the mefentery
is connected. The time of their coming to fuppuration is pointed out by
thofe frequent cold rigors. And the fanies being extravafated, left ulcers in
thefe parts, and filled the abdominal cavity. Which there growing more and
more acrid, by ftagnation, irritated the coats of thevifcera, and of the inteftines
in particular; and by this means an inflammation of all the vifcera was
brought on, and the motion of the inteftines befides was inverted. Hence
the volvulus.
You may compare this obfervation with thofe of the celebrated Mauchart
(0), and Verdriefius (p), not on account of the volvulus, which feems to be
but juft hinted at in one, but by reafon of the pains of the belly, efpecially as
in both of them were ablcefles of the mefentery, in like manner, in one
open, fo that the belly was fill'd with fanies, in the other not open'd, and
the inteftines which were, here and there, infected with a fphacelus, coher'd
clofely one with another, and with the omentum.
2.3. Another man, of the fame age with the former, and of the fame habit
of body, but of a pallid colour, having been feiz'd, two years before, with
an ardent fever, was at length freed from it without a'ny perceptible traces
(#/) Aft. cit. t. 7. obf. 101. (a) Eph. n. c. cent. I. obf. 14.
(*) Com. cit. a. 174^. hebd. 40: n. 2. Q>) Aft. cit. torn. 1. obf. 87.
of
Letter XXXIV. Article 24, 25. 147
of a crifis •, and was afterwards affected with a great thiril, a very great
weaknefs of the head, and ilomach, and a defect of the ftrength. Being
every day troubled with thefe fymptoms, he was feiz'd with a great opprel-
fion of the heart, which, in the night when he was about to fall into a Qeep,
was fucceeded by a tremor of the whole body. He was thought, by other
phyficians, to labour under a confumption, but by Valfalva, to have a re-
dundancy of water in the cranium, who alio prefcrib'd fuch remedies as are
generally made ufe of in hydropic cafes. But the patient, in the mean
while, drinking a great quantity of new wine, with his bottle companions,
was feiz'd with a great pain in his belly, which was unfix'd however, but join'd
with flatus, with a vomiting of bilious matter, and with a celerity of the
pulfe. The next day in the morning, as the pain was not only more violent,
but fix'd in a certain part, which was exceedingly painful when touch'd,
Valfalva, fearing inflammation, order'd a vein to be open'd. Yet all re-
medies were to no purpofe, and the patient died in the. beginning of the
fourth day.
In the belly every thing was found to be in a found (late, except the
inteftinum ileum, which was, in a great part of it, inflam'd.
In the thorax was nothing particular to be obferv'd, except a very large
polypous concretion in the right ventricle of the heart, which was produe'd
from thence into the vena cava. "Within the cranium was found a great
quantity of ferum, with which the ventricles of the brain were alfo fill'd.
The glandules of the plexus choroides were very large, and abounded with
a great quantity of ferum : and the compages of the brain was lax.
24. How dangerous it is for confiderable fevers to be iblv'd without any
crifis, is confirm'd by the firft part of this hiflory. And how juft both the
opinions of Valfalva were, is demonftrated by the appearances found in the
head and in the belly. But as to there being only a vomiting in this patient,
and not a volvulus, as in the former, you will not inquire into the cauies
thereof, when you have compar'd the diflection of this body with that of the
former, or of the following : which, if I remember rightly, was made by
me, in the hofpital of incurables at Bologna, in the year 1705.
25. An old man of feventy four years of age, of a flender habit, and given
to wine, had begun, for a month pail, to walk in fuch a manner, as to bear
chiefly on his left leg. Which his domeilics had obferv'd more than himfelf-,
at leaft he faid nothing of it, nor complain'd of pain in any part. Two and
twenty days after he was feiz'd with a wandring pain in his belly, join'd with
no fever, which he, without confulting any one, expell'd by taking theriaca.
But after twelve days had pafs'd over, he was feiz'd, about noon, with a pain
in the upper part of the iliac region, on the right fide, which was very op-
prefTive, and as he himfelf faid, like that which would be caus'd by the
gnawing of dogs. The pain'd part was fwollen, but had not chang'd its
colour, and if you touch'd it was foft : but preifing your hand down pretty
low, you perceiv'd a hardnefs. The pulfe, though in other refpects good,
was quick and frequent. His eyes were funk into their orbits. His tongue
was dry. He pafs'd a bad night.
On the fecond day of the difeafe his pulfe was very large, and vibrating.
The pain and the tumour extended themfelves to the middle of the belly,
1 U 2 and
148 Book III. Of Difeafes of the Belly.
and at length were continued towards the left fide. Blood being taken away
from his right arm, to the quantity of feven ounces, had no ferum in it-, but
had a yellow and thick cruft. He had a naufea to a considerable degree,,
but not lb as to caufe his food to be thrown up from his ftomach. He went
to ilool freely and without any uneafinefs. The fecond night was extremely
bad.
On the third day his pulfe was low: he had frequent eructations, which,
were bitter, and acid : his fpeech was vitiated as if by a convulfion : he was
delirious at times, as was demonftrated by the child ifh, and trifling things,
which the patient related.
On the fourth day his limbs were every now and then convuls'd, and the
whole, body remain'd rigid for a quarter of an hour : during this convulfion
and rigidity there was no pulfe : and,, on the contrary, when the convulfion
and rigidity were gone off, the pulfe alfo return'd, and was much like that
of a healthy perfon, except that it was low, and when prefs'd upon by the
fingers gave no reliftance. Refpirarion becoming very difficult after that,
although the tongue was now moift, and the patient was no more delirious,
he threw up the faeces by vomiting, and a little after, which was in the
evening of the fame day, he died convuls'd.
The abdomen being open'd, the left lobe of the liver was found to be lax,
and univerfally affected with a fphacelus. The ftomach and the interlines,
efpecially the fmall interlines, were in fome places red, in fome livid, and
in others black. But the beginning of the colon, where it lay contiguous to
the mufcles, which cover the hollow furface of the os ilium, together with
thefe mufcles, was univerfally affected with a gangrene, , and fo connected to
them that it could not be feparated without laceration. From thence the
livid ferum, mix'd with pus, which had been (een in the cavity of the belly,,
feem'd to have been extravafated, as a- matter fimiiar to it was contain'd in
the interlines.
26. As to the beginning of this hiftory, it is not very abfurd to fuppofe,
that fome diforder had been, gradually, generated in thofe mufcles, which I
juft now fpoke of, from whence the neighbouring crural nerves were corrr-
prefs'd, and to fuppofe it to have happen'd from hence, that the patient,
when he walk'd, bore chiefly upon his left leg. As to the diforder itfelf,
inflammation and putrefaction afterwards coming on, the deprav'd and cor-
rupted juices fo vellicated thofe nerves, as to caufe a convulfion of the
whole body. And it is probable, that in a boy who was carried off by the-
iliac pafiion, the convulfions. of the whole body are not to be afcrib'd to any
other caufe, than to- that of a putrid matter flowing from the interlines, with
which the fame mufcles were bedew'd : for. thefe convulfions arretted the
lower limbs in particular, and were, as you read in this fourteenth fection of
the Sepulchretum (q), fo obflinate, that the boy at length died convuls'd.
But in what manner the inflammation,- ia this old man, crept into the
contiguous interline, and other circumftances that I have defcrib'd, there is
no occafion to explain. I go on therefore, to an obfervation, which that
part of the colon, being inflam'd, recalls to my mind, and which was com-
(f) Obf. 21. in additam:
municated'
Letter XXXIV. Article 27, 28. 149
municttcd to me, two years before I made the preceding; by that very
learned and humane man M. Anthony Laurentio, who is, at pre lent, one or*
the pontifical archiaters.
27. A woman, who had had a fall on her back a year before, having
been lately afflicted, for fome days, with a very great, deep feated, and ex-
cruciating pain in her belly, join'd with vomitings, was taken off thereby.
Her ftomach was found to be furprizingly contracted, and tlie caecum in-
teftinum of the ancients lb dilated, by yellow, and iemifluid faeces, that it
refembled the ftomach. This inteftine had been feiz'd by an inflammation,
which alfo began to diffufe itielf through the neighbouring vifcera.
28. If that fall had any reference to the caufes, which, gave rife to tln'3
dileafe of the woman, it is to be fuppos'd that fhe had fall'n upon her back
in fuch a manner, as to hurt the right fide of her belly and that part of the
colon which lay in this fide. And that this part of the inteftine having, for
that reafon, the power, by which it propels the fasces upwards, more and
more diminifh'd every day, was, at length, expanded by the ftagnation of
its contents, in the manner I have defcrib'd, particularly with the cascum
that was fubjoin'd to it, and that, on account of the diftraction of its coats,
it was afiected with a very fevere pain, and by reafon of the compreflion of
the vefiels inflam'd. And if the woman had dragg'd on her life a little
longer, perhaps fhe, alfo, would, like fome of thofe of whom. I have already-
fpoken above, have vomited up excrements in a filthy and miferable manner,,
or rather fomewhat extremely like excrement. For many being deceiv'd by
this fimilarity, have fuppos'd that what had already pafs'd into the large in-
teftines, was thrown up by. vomiting in a volvulus, which muft happen much
more rarely than they imagine, by reafon of the valvula Bauhini being in-
terpos'd, and this is alfo fhown by other circumftances, which are taken no-
tice of by me in the Adverfaria (r).
That they have really been deceiv'd by this fimilitude, it is not difficult
to demonftrate, by producing many obfervations of vomitings of that kind,
even in thofe bodies, wherein the paflage from the large inteftines to the
mouth was entirely fhut up. For, to omit others, where this paflage was
intercepted by a very clofely confin'd hernia, or by an obftruction, or coalition,
of the tube, turn, by way of example, to that obfervation of Henricus ab
Heers in the Sepulchretum (s). A mountebank had tied up the intef-
tinum ileum of a boy, who had a rupture, together with the omentum,
with a piece of iron wire, fo that nothing ar all could pals through. And
the boy died, as the obfervation fays, " throwing up his excrements by his
" mouth." Add to this, the feveral experiments of the celebrated Hague -
not (/), upon cats and dogs : which vomited up excrements, to appearance,
though a firm ligature was put upon the fame inteftine. Who would not,
at firft, have imagin'd, that thefe fasces were carried back from the large
inteftines, if he had not known that the fmaH'inteftines were quite ihut up.
For without doubt, thofe ingelta which are carried down from the fto-
mach to the inteftines, being mix'd with the juices of the ftomach, and fooiv
(>■) in animad. 9.. (.•) Mem. de L'acad. r. des fc. a. 1713.
W Qbf. 24. §. 3..
aftc*
2 5° Book III. Of the Difeafes of the Belly.
after with the juices of the interlines, with the fuccus pancreaticus, and the bile,
and having had many of their finer parts carried off into the lacteal veffels,
are under a neceffity of making that delay in the fmall inteftines, when their
paffage is obftructed, which they naturally would have made in the large,
and even a greater delay when thefe fmall inteftines are inflam'd ; fo that
they will of courfe contract the fame putrefying odour in the fmall inteftines,
that they us'd to contract in the large, and may be call'd excrement without
any impropriety, as is afferted by Piccolhominus (u), who, for this reafon,
denies that it is necefTary for the remains of the ingefta, after the chyle is
taken up, to reach the large interlines, in order to acquire the nature of
excrement. But although they are not deceiv'd in this, they are, neverthelefs,
from hence carried into an error, when they fuppofe this fascal matter to
come from the large inteftines, which comes in fact from the fmall.
29. But that the fasces may be carried back quite from the large inteftines,
is demonftrated by fuppofitories and glyfters being thrown up by the mouth,
in patients who labour under the iliac paflion. I feem however to have
faid, fufficiently, what I think of fuppofitories, and of glyfters likewife, in
the Adverfaria (x). But as I have fince read, in the writings of a confider-
able author, that this happens " frequently," and in thofe of another, have
feen this circumftance explain'd, without fuppofing an inverted motion of the
inteftines, in a method entirely new •, I have determin'd to add fome few
things, in this place, upon both of thefe heads. And in regard to the firft,
Galen has not only taught us, in more than one part of his works (y), that
the motion of the inteftines is inverted, in an iliac paffion, and even without
it, but alfo in the third book de fymptom. caufis (z) has afferted once and again,
" that fome perfons have had part of the glyfters, that have been injected,
" carried into the ftomach, fo as to be thrown up by vomiting : and befides,
" that excrement was frequently thrown up, in iliac paffions, that prove
*' mortal."
But from his time, quite down to the time of Jo. Mathasus de Grado (a),
that is from the fecond age of the chriftian aera, to the fifteenth, I do not
remember to have read any one who confirms it. After him, and in the
fixtcenth century, was one, that is Julius Alexandrinus (£), who fays that he
had feen it, " not very often, but fometimes," as Francus Hildefius has
faid he did twice (c). But in the laft age, and in this, a great number indeed
have afferted it. For you may read three obfervations of Abel Rofcius (d)t
of Daniel Sennertus (<?), as it appears to be, of John Henry Lavaterus (f),
of Luke Schrockius the elder (g\ and of John Mery (b), each one, and
many from the compilers of the Bibliotheca Anatomica (i) : and befides,
(«) L. 2. anat. prxledl. K. (</) Apud Hildan. cent. 6. obf. 70.
(*) Animad. cit. (e) In hac 14 fepulch. fett. fchol. ad obf. 20
{y) De nat. facultat. 1. 3. c. 13. & in Hipp. §. 13.
de vid. in acut. comm. 3. n. 33. (f) Thef. 6. cit. fupraad. n. 16.
(z) C. 2. (g) Eph- "• c- dec- 2- a< 5- fchol. ad obf.
(a) Apud donat. de hift. mirab. 1. 4. c. 3. 195.
\b) Apud Schenck. obf. raed. 1. 3. fub. tit. {b) Obf. 1. cit. fupra ad n. 16.
variar. rer. vomit. (') Tom. 1. p. 1. in adnot. ad Peyer. exercit.
(c) Ibid. >• de gland, intefl.
without
Letter XXXIV. Article 30. 151
without the iliac or colic paffion, one of Peter Bordlif*), another of Fre-
deric Loflius (7), a third of George Segerus (»;), a fourth of Gabriel Clau-
derus (»), and a fifth, in fine, or Peter Rommelius (o) •, for fo many are
there, that I at prelent call to mind. You yourlclf will eafily find others.
But if you fhould even find as many as thefe, you would, I fuppofe, fay that
the throwing up of glyfters by the mouth, was not a vciy rare thing, but
would not fay that it is frequent. For the greater part or phyficians have
never ilvn it, even thofe that are the mod experiene'd ■ as their writings
teftrfy, where they happen to make mention of thefe oblervations, for in
order to prove the circumftance, they produce the teltimony of others, in-
fix ad of their own.
30. But let us now fee by what new method the throwing up of glyfters
by the mouth is explain'd. It is fuppos'd that in a volvulus, all the intef-
tines are full, or nearly full, of fluids that are either continually flowing into
them, or taken in by the patients : and that there is fome obftacle or other
in the lower part of the rectum, which hinders the difcharge of thefe fluids,
but which may be got over by thofe who inject glyfters. The glyfters, then,
that are thus injected, increafing the fullnefs, and diftention, of the inteftines,
and an alternate compreffion of the abdominal mufcles, and diaphragm,
coming on, it is fuppos'd that they are driven to the part where there is the
leaft reliftance, and that, being mix'd with thefe humours, they are at length
thrown up by vomiting. And that the valvula Bauhini does not refift, as it
will be naturally kept open, if you allow a fullnefs of all the inteftines. Nor
is there any need of the inverted motion, efpecially as in beafts, who were
already feiz'd with a vomiting, on account of a ligature being made upon
the ileum, this motion could not be obferv'd, and even not the periftaltic
motion, which feems no longer to be fully acknowledg'd, in living and
healthy bodies, if you attend to thofe things which are in the latter part of
this explication.
When I firft read all thefe things, although there were fome which I found
could not be eafily prov'd, yet I began to do, what ought never to be
omitted in the inveftigation of truth, that is to attend not only to the ar-
guments which might be produe'd againft this explication, but alfo to thofe
that might be produe'd in favour of it. In confequence whereof I obferv'd,,
that fome of thofe fuppofitions, which the ingenious author had confirmed,
not only by his own reafonings, but by his own experiments, were alio equally
prov'd by mine. For as to what relates to the plenitude of the inteftines, from
the obftacle quite to the ftomach, this has been found in the manner he fiup-
poles, by my obfervations alfo upon human bodies (which he complains of
being without) that had been afflicted with diibrders of this kind ; as the hif-
tories of the hufbandman (/>), the porter (j), and in great meafure that of
a certain woman (r), which I have given you, demonftrate. And fuppofing
the fullnefs not only of the fmall, but of the large inteftines, 1 law that the
(i) Cent. i. obf. 17. (0) Earund. dec. 3. a. 7. oLf. 39.
(/) Vid. fchol. modo eit. in eph. n. c (p) Supra n. 9.
(«) Earund. dec. 1. a. 9. obf. 94. (q) N. 18.
(n.) Earund. dec. 2. obLciu Q) N_h..
" impediment^,
i<52 Book III. Of Difeafes of the Belly.
u impediment, which I had, in a general way, hinted the necefiity of in-
*' quiring into, in the Adverfaria (j), appear'd, by means of which impedi-
" ment, being interpos'd for a time," the valvula Bauhini " could not be
" properly fhut up ," I fay for a time ; for if it be fuppos'd perpetual, it
will not be underftood, by what means this valve may have immediately
return'd to its office, after having fuffer'd glyfters to pais through it, as has
been feen in fome of thefe cafes which were pointed out juft now (/).
P'or in thefe cafes, the explication of thofe who have conjectur'd that the
valve is either ruptur'd, or become paralytic, in patients afflicted with the
ileos, would not be iufficient. As this laft conjecture, I fuppofe, cannot
take place, even when the beginning of the colon is fuppos'd to be im-
moderately dilated, with a great quantity of matter, which is collected to-
gether. For although the valve, by reafon of the flefhy fibres of the two
inteftines whereof it is compos'd being become paralytic, mould lofe that
power of conftringing itfelf, whatever that power might be •, yet the two
frasna, or bridles, which I have added, are fo difpos'd tranfverfly, on one
fide, and on the ot'ruir, through the internal furface of the colon («), that
by a furprizing utility, the more this inteftine is dilated, the more do they
-conflringe the chink, or aperture, of the valve, which ufe I believe it very
often performs in life, when, perhaps, there is a great quantity of matter con-
tain'd in that part of the colon, and the mufcles of the abdomen are in ftrong
action to comprefs and propel it: and as I do not doubt, but that thele
things, in regard to the flructure of this valve, and its frsena, which I have
defcrib'd in words, and reprefented in plates, in the Adverfaria, are admit-
ted by you ; fo 1 could wifh that thefe things, and fome others, which relate
to me, had been confider'd a .little more attentively by fome perfons : but of
thefe things on another occafion.
Finally, to omit other things, as to that action being attributed to the
mufcles of the abdomen, and the diaphragm, which is generally attributed
to the inverted motion of the inteftines, that this is not done without reafon,
may be prov'd by thofe cafes, in which the iiecs has happen'd on account of
thecxpuliive faculty being aboliuYd, or from a lofs of tone in the inteftines,
as has been hinted at above (x), according to the opinion of Salius, and
Ruyfch. In which place the authority of Boerhaave (y) may alfo be produe'd,
who afferts " that in the numerous directions of living animals, he had
" never feen a periftaltic motion in the large inteftines," and he wonder'd.,
for this reafon, " that glyfters mould neverthelefs be thrown up, from the
" large inteftines," by the mouth •, for he did not doubt but this did hap-
" pen " ibmetimes, as men of learning and authority bore their teftimonies
" to it."
31. But notwithstanding I had obferv'd thefe things to be favourable to
tke proposed explication, other things arofe, by way of objection to it, which
very evidently argued againftit. And not to take up too much of your
lime, this in the firft place, that if all the inteftines are fuppos'd to be full, or
(-) IITan-mad. 51. (.v) N. 12.
(.') N. 29. 0) I'r.rlect ad initit. §. .3 16 in fin-
\u) Advcri". 5. fig. ;.
•nearly
Letter XXXIV. Article 31. 153
nearly full, it is not poffiblc to conceive how the glyfters can be thrown
up by vomiting, mix'd, as is laid, with other fluids, but quite pure, as they
were given, and that not very long after their injection, and without any
great chfeharge of thole humours, with which the whole canal, from the
redum to the ltomach, is EU'd, or almolt fill'd, having preceded.
For read the obfervations of Rofcius, of Schrockius the elder, and of the
compilers of the Bibliotheca Anatomica, which were made upon volvulou-
patients, and which 1 have pointed out above (2:) : read alio thole that I have
taken notice of from Loflius, Segerus, Clauderus, and Rommelius (tf), where
there was even no volvulus, lb that very ftrong compreflions of the mufcles
could be fuppos'd •, nor was there any obftacle, except a flight coftivenefs in
one or two, which could have confin'd the humours in almolt the whole tube
of the inteltines. You will find among the feveral obfervations, that the
glyfters were thrown up by the mouth, " wholly, entirely," and thefe " pure
" as they had been applied, nothing at all chang'd," after they had been
*' rctain'd in the inteltines for an hour, after about the fpace of an hour,
" after a quarter of an hour, when a quarter of an hour had fcarcely elaps'd,
" in a moment of time," without any vomiting being any where taken no-
tice of, betwixt the times of injecting the glyfter, and throwing it up by the
mouth, not to lay without fo confiderable a vomiting as you perceive there
muft have been, had the inteftines been all full.
Since, therefore, the inteftinal tube, in thefe cafes, was neither full, nor
nearly fo, it appears, without doubt, that another explication muft be fought
after, from which it may be clear, not only what caufe could propel the
gtyfters, from the rectum to the ftomach, but alio, by what means die val-
vula Bauhini could be kept open. And we muft take care, now in parti-
cular, when there are many who call into queftion, the powers of the dia-
phragm, and abdominal mufcles, to excite vomiting •, we muft take care, I
fay, left, as to what relates to the firft caufe, that be too haftily rejected,
which even from ancient times was plac'd in the inverted motion of the in-
teftines. For although this motion was certainly not readily to be allow'd
of, where the inteftines were tied, diftended, inflam'd, or paralytic, why is
it to be denied where there is none of thefe circumftances ? And there could
be none of thefe circumftances, in thofe obfervations which were taken when
no volvulus was prefent, nor was it neceifary even when this was prefent,
or at leaft it was not always neceflary, that it fhould be in a great part of the
inteftines, and efpecially in that which I particularly refer to here, that is in
the large inteftines.
Why, therefore, muft we altogether, and at all times, reject this caufe,
and fuffer it to have no part in the performance ? Is it becaufe the periftal-
tic motion is perhaps fcarcely to be acknowledged any longer ? How is it
then ? Is it pofnble for the nature of animals to be fo chang'd, that in out-
age the circumftance fcarcely appears any more, which thofe very ancient
obfervers have feen, in confequence of whofe opinion Cicero has exprefly
written (b), " that the inteftines both conftringe and relax themfelves alter-
" nately," either to agitate and prepare the food, or to drive the remains of
(?) N. 29, (a) Ibid. (i) L. 2. de nat. deor.
Vol. II. X it,
154 Book IK. Of Difeafes of the Belly.
it, after concoction, downwards ?■ But left it fhould happen to any one of
thofe whom I have refer'd to, in the preface to the lecond Adverfaria, near
the latter end, that this paffage of Cicero, alfo, may feem " to be quote,:"
by me, " by way of pretty fevere reproach," I choofe rather to neglect what
might be replied on this occafion, and to come down from the ancients, to
the more modern obfervers. Shall I then forget the great number of obler-
vations, not only of others, but of my own alfo, on dogs, fheep, and rab-
bits, diffected alive, though this motion often occurs to the eyes of thofe
perfons who do not look for it, and even, as happen'd in a rabbit particu-
larly, a motion alternately antiperiftaltic. But it is very little to the pur-
pofe, now, to fhow that one of thefe motions has been obferv'd in human
bodies alfo, and fometimes both, fince the celebrated Haller (c) has produe'd
examples thereof: to which, however, if you pleafe, you may add that of a
matron, who had a very confiderable omphalocele, or umbilical hernia, which
was feen by the compilers of the Bibliotheca Anatomica (d). And the fame
Haller (<?), even before he publifh'd fo many experiments (f), caution'd us
from believing that becaufe it had happen'd to his great preceptor, that he
never, as I have faid, faw a periftaltic motion in the large inteftines, it had
therefore never been feen by any one -, for he quoted Wepfer, in particular,
who faw it very evidently in thefe inteftines likewife, and not only the peri-
ftaltic, but alfo the antiperiftaltic, as you will learn from the paffage of Wep-
fer, which is, in like manner, transfer'd into the Sepulchretum (g).
32. From thefe things, which I have confider'd on both fides of the ques-
tion, you will eafily perceive, that any probable caufe, which tends to explain
the fymptoms that happen in the volvulus, particularly thofe that are diffi-
cult, and not as yet fufficiently clear, ought not to be entirely rejected.
But as to the caufes which create an obftacle to the matter, that defcends
through the inteftines, if you inquire of me, whether I ever found that con-
torfion, or twifting, which was formerly fo much talk'd of, or at leaft an in-
tus-fufception, as it is call'd, which is even very frequently confirm'd by the
more modern authors-, I fhall ingenuoufly anfwer, that I have as yet lit on nei-
ther of them, juft in this manner, as I mall explain hereafter (*). Yet I do
not, for this reafon,„ in regard to the firft caufe, fufpect any of the obftacles
of this kind that are defcrib'd, but only becaufe, while the connection of the
inteftines with the mefentery is preferv'd, this contorfion cannot be con-
ceiv'd.
But the fecond, or the fufception of the inteftine within the inteftine, is
not only conceivable, while the connection with the mefentery is preferv'd, but
is alfo very injurious, on account of this very connection. For when one
part of the inteftine enters within the part next to it, the portion of the me-
fentery, that isannex'd thereto, muft enter in at the fame time. Wherefore,
if it (lay there for any confiderable time, and any conftringing caufe come on,
the motion of the blood, through its veffels, being retarded, it will fwell to
(c) Ad Eoer. prxleft. §. 93. n. 6. (f) De refpir. p. 3.
[d") Tcm. 1. p. 1. adnoc. penult, ad War- \g) Schol. ad. §. 2. obf. \. hujus feet.
8»on. de mcfent. (*) N. 3^..
(0 Ad cit. prxleft. §. 107. not. 3. & §. 109.
fuch
Letter XXXIV. Article 32. 155
fuch a degree, as to hinder the inteftine that has enter'd in, from receding
and likewile prevent the pafiage of the matter that was about to delccnu
through the cavity ; to fay nothing of the fphacelus that at length comes on,
on account of the circulation of the blood being entirely precluded, which,
as the illuftrious Haller law (h), was the caufe of death in a certain man.
And every part is fo much the more conftring'd and comprels'd in that place,
in proportion as the part of the inteftine which is pufh'd within the part
neareft to it is larger or more complicated ; for this complication has been
lbmetimes fo great, that a portion of the inteftine, which while thus conglome-
rated together did not exceed half an inch in length, was equal almoft to two
fpans when drawn out (/'). And lb much the greater extent enters in, in pro-
portion as the caufes are greater, or more long-continu'd, which impel the
part that enters, and dilate the part which receives.
Among the latter caufes, for the mod part, is flatus, and among the for-
mer, fomctimes, is weight, as in the obfervation of the fame compilers of
the Bibliotheca Anatomica (&), whom I have once and again quoted, which
is an extraordinary obfervation, not on that account only, but alfo becaufe
the fufception had happen'd in the colon, in which I read that very few had
ever feen it befides Ruyfch, who confeffes (/) that he had feen it only once,
whereas he had feen it fo often in the fmall inteftines, that no body more fre-
quently. However, no caufe is fuppos'd to be more common than convul-
five motions : which the experiment of Peyerus, wherein the inteftines of a
living frog were ftimulated, in more places than one, fhows to be capable
of producing this effect : this experiment you will read in the Sepulchre-
turn (m). And the fame thing feems to me to be confirm'd, by the obferva-
tions of Peyerus himfelf (»), but in particular by thofe of Ruyfch (<?). For
the former law in the inteftinum ileum of a girl, in which were three fufcep-
tions, worms " roll'd up together, as it were, in one place ;" and Ruyfch
faw the very portion of the ileum, which had enter'd into another, in a man,
" fill'd with worms circularly plac'd," and a fecond time he fhow'd a fufcep-
tion of the fame inteftine, " in a boy, to have worms in it." And it is very
evident that the inteftines may be very much irritated from worms.
Indeed that eminent phyfician Heifter (/>), having found a double fufcep-
tion, in the fmall inteftines of a boy of twelve years of age, and having ob-
ferv'd the fame inteftines to be " very full of worms," thought it " worthy
" to be obfcrv'cl in the practice of medicine, efpecially if they are very young
" fubjects, which fall under our care," that the iliac pafiion may fometimes
arife from worms alfo. And for this reafon, perhaps, it has been, that I
have feen the greater part of the fufceptions remark'd in children. While
I attend pretty diligently to fome of thofe things, which I have hitherto taken
notice of, I cannot help adding my own obfervation in this place, in reading
of which, if you begin to wonder that I had juft now denied my ever having
feen a fufception of the inteftine, you will, atleaft, ceafe to wonder, when you
have confider'd thofe things which I fhall fubjoin to the obfervation.
(h) Strena anat. n. 9. (m) Schol. ad § 8. obf. 20.
(1) Vid. Sepulchr. §. 2. modo cit, (») §. modocit.
(k) Adnot. cit. fupra ad n. 29. (0) Thef. anat. 4. n. 14. & Thef. nov. n. 57,
£/) Adverf. anat. dec. 3. 5. \p) Eph. n. c. cent. 1 & 2. obf. 198. n. 3.
X 2 33. A
156 Book III. Of Drfeafes of the Belly.
33. A virgin of forty-five years of age, having received a violent blow on
her head from a fall, not only vomited in the beginning, but continually •, (he
liv'd in this hofpital more than twenty-one days, in which time, however, fhe
icem'd frequently upon the point of expiring.
In the abdomen ; for I only infpedted the vifcera of this cavity, and that
not with a view to the difeaie-, the inteftines were ftill warm, although it was
many hours after death, that I handled them, and at leaft one hour from the
time of cutting into, and laying open the abdominal cavity, as I was en-
gag'd about fome other bufinefs in the mean time, and although it was at a
time of the year which is generally cold, that is about the middle of De-
cember, in the year 1724, when the feafon was extremely cold. Part of the
fmall inteftines was diftended with flatus, efpecially that part which lay under
the cascum, for which reafon this inteftine, with its appendicula, was turn'd
forwards : the remaining part was reddifh, and had a kind of putrid fmeli.
In this part I faw the fulception, of which I am fpeaking, not lefs evident,
and even fomewhat longer, than it is delineated by Ruyich (q).
But while I was defirous to learn very diftindlly, in what part of the intef-
tines it was, and how clofe it was, and for that reafon turn'd oyer the inte-
ftines gently, as one generally does, in order to begin from the other head of
the fmall inteftines, I found out this head very clearly, but the fulception I
could no more find. For all the fmall inteftines being examin'd accurately,
from one extremity to the other, and back again, and run over with the
hand, this fufception no where appear'd,. and indeed not a trace of it, fo that
it was very plain it had not been clofely conftricled. Then opening the fmalL
inteftines, which was all.that remain'd to do, I faw,. in the duodenum, a mat-
ter like fluid feces, in the neigbouring tract of the jejunum, a round worm,,
and in the fame tract, and the neighbouring part of the duodenum, I faw,-
here and there, bloody fpots, with which both of them were diftinguifh'd in-
ternally,, as if from inflammation, which had begun to be the confequence of.
the irritation, And in the remaining inteftines, and the abdominal vifcera,^
I. alio obferv'd, and demonftrated, many things, but not fuch as had refe-
rence to the difeafe, if you except fome that were remark'd. in the organs of
generation, and in the bladder, or rather in the urethra. For the uterus be-
ing laid open with the knife longitudinally, from the fanguiferous vefTels,.
which appear'd to be parallel throughout the internal furface, fome black cor-
pufcles, as it were, feem'd to be prominent, here and there, fo that I at firft.
took them for very fmall varices. But when I examin'd them in the morn-
ing, by the light of the fun, I found that they were not varices, .and indeed
I much doubted whether they were really in thefe veiTels. For I faw that
two larger bodies, which lay in the common boundaries of the bladder, and
urethra, were peculiar iubftances, brown in their colour, and rcundifh in
their figure, and when I touch'd them, I perceiv'd them to be hard •■> fo that
I believ'd them to be cd\cu\\fui generis > which had been concreted under that
internal coat, and rais'd it up-, and that the others, as they were lefs in fize,
were alfo lefs hard, and not roundifh, yet were made of a matter of the fame
kind, and in the fame manner, but were not yet perfectly form'd.
(?) Obf. ch'r. anat. fig. 74.
Letter XXXIV. Article 33. 157
As I had obfervM this kind of diforder which is perhaps new, and which,
in proceis of time, would, probably, have made the urethra very narrow, and
■was certainly injurious even now ; I diflected the uterus, to fee if I could find
the original lprings- of that whitilh, and thickifh humour, with which I law
that the vagina was too much moiften'd. But I law nothing that was not
ufual, in this cavity, except a fmall heap of little veficles, which was pro-
minent in fuch a manner, that the area thereof did not exceed the circumfe-
rence of the nail of the little finger. This was on the anterior furface of the
cavity of the uterus itfelf, on the right fide, and nearer to the upper part of
the fame cavity, than to the cervix uteri •, lb that, atfirft, I fufpedted it to be
the beginning of the excrefcence, of the fame kind with that which you have
read my delcription of, in the cavity of the uterus, frequently, upon other
occafions. And this fufpicion was confirm'd by the prominence : but the na-
ture of the veficles, which cover'd the face of the prominence, did not agree
therewith >. for they themfelves, and the mucus they contain'd, were entirely
of the fame kind, and had the lame natural appearance, with thofe that were
below in the neck, in greater number, which I have formerly pretty, well de-
fcrib'd, and reprefented by figures (r) ^ not hydatids, which were not want-
ing here, alfo, at the tubes, and near the ovaries, white, hard, and ftri-
gole.
But veficles containing a limpid mucus, which could be drawn out into
threads, plac'd in fo high a fituation, as in this virgin, and there collected
into a heap, I do not remember to have feen, except very feldom. For if they
had always appear'd in this manner, one of the great difficulties, in the
opinion of Nabothus, would-be remov'd.
34. But of this on another occafion. Now let us return to the intended
difcourfe. You fee that in this virgin, a part of the inteftine had fallen into ;
the part which was neareft to it : that on one fide there was flatus to dilate •, and'
on the other a worm, which, by ftimulating, might contract the inteftine,
and excite inflammation: that an obftinate vomiting was not wanting, nor yet'
in the duodenum, a matter like liquid fasces. All thefe circumftances con-
cur'd to prevent me from omitting this hiftory here. But the very violent
blow of the head, which of itfelf generally excites a vomiting, the very flight
inflammation in the fmall inteftine, which feem'd to be but lately, begun, and
which, perhaps, is to be accounted for as is hinted in the nineteenth letter (j),.
but, in particular, this fufception, which was fo very lax that it eafily be-
came evanid, without leaving any traces behind it, have influene'd me not to
confider it as the caufe of thefe vomitings, nor yet to number it among thoie
caufes of which I am at prefent treating. For I do not here refer to thofe
which are frequently found, and are eafily develop'd, fuch as I fuppofe thole
three to have been, that Abraham Vater (t) faw in the inteftinum jejunum
of a girl, without any figns of a volvulus •, and fuch as-they probably wer<>
that are defcrib'd in the fame inteftine of three bodies, in the obfervation of
the celebrated- Hommelius («)» wherein no mention is made of any of thefe
fymptoms ; and, not to be too prolix, fuch as they were, without doubt, that
(r) Adverf. anat. i. n. 32. & tab. 3. (a) Commerc. litter, a. 1743. hcbd.42. in
(.<) N. 18. fin;
(/) Progr. edito a. 1727. m. April,
2 - are
1 5 8 Book III. Of Difeafcs of the Belly.
arc defcrib'd by the celebrated Haller, not in the Strena Anatcmica, from
which I quoted one above (.v), but in the Opufcula Anatomica (y)t for thefe
were many in number, and had various fituations, fo that one of them was
from the lower part of the colon, in the upper part of the inteftinum
rectum.
And fome are even met with that are not fo eafy of evolution, as that
which was found by the celebrated Jo. Phil. Burgravius (z), cc in a pretty
" confin'd date," yet without any fign of the iliac paffion being join'd with
it: was it becaufe no inflammation had come on? Though indeed an inflam-
mation had not fucceeded to the other, which was feen by the fame per-
fon (a), yet there had been fome tormina at lead, and a vomiting of the re-
medies which were taken in : did thefe fymptoms arife from the inteftine hav-
ing been pufiVd within itfelf, to twice the depth of the other, in this fecond
cafe ?
But Hartmann (b) found an intus-fufception of the inteftine to a confider-
able depth, and that in three places, nor equally eafy of evolution in them
all •, and he even found the inteftine to be there " fomewhat turgid externally,
" and bloody, an evident mark of the tumor remaining even in a portion
" that was cut orTj" nor was a very long worm wanting in the fmall intef-
tines of the fame body : yet he mentions no fymptoms of a volvulus ; but
even remarks, " that the inteftines had perform'd their functions very well,
" doubtlefs, becaufe the paflage was not entirely obftructed by thefe fufcep-
" tions." And Jo. Guil. Widmann (c) found alfo a much longer portion of
the inteftinum jejunum, that is more than a geometrical foot, fallen within
the part next to it, " much ftreighten'd and comprefs'd, and infected witli a
" livid colour," and this after pains which had been indeed very fevere, and
almoft continual vomitings, yet not of matter like feces, nor attended, as
he fays, with a fuppreflion of ftools, which was probably becaufe the inverted
portion, although narrow, was found to be ftill " pervious."
Wherefore, I fhould readily believe, that thefe two fufceptions were ftill
more pervious, and not only fhorter and lefs comprefs'd, which that celebrated
man Jo. Rod. Zuingerus (d) found in the inteftinum ileum, together with an
incipient gangrene, who certainly would not have omitted to mention fome
marks of an iliac paffion, if any had preceded : but on the other hand, I
fhould fuppofe thofe two were lefs pervious, which Valentinus (e) found in
the fame place, as he relates the fame lymptoms as Widmann, and does not
doubt but a vomiting of excrement would have come on, if the boy had liv'd
fome time longer : which you will find did come on, in another defcrib'd by
Hoffmann (f) ; the fufception, which was in the fame inteftine, ferving at
once to prevent the paflage of the flatus, with which the upper inteftines were
diftended, and that of a putrid humour which was feen in the ftomach, of the
fame colour with that which had been thrown up by vomiting.
(x) N. 32. (<-) Earund. cent. 6. obf. 89.
(y) Obi. 27. (d) Earund. cent. 7. obf. >•>;.
(z) Aft. n. c. torn. 7. obf. 5. {e) Earund. cent. 3. obf. 1.
{a) Earund. t. c. obf. 80. (f) Med. rat. t. 4. p. 2. f. 2. c. 4. obf. 4.
(t>) Eph. n. c. dec. 3. a. 5 & 6. obf. 207.
To
Letter XXXIV. Artielc 35. 159
To thefe you will add, in particular, the obfervation of the celebrated
Weifilus (tO, who in the body of a woman, that died ni'ter having been af-
fiieled with violent pains of the belly, join'd with an obftinate obltruction of
the inteftines, and at length with a volvulus, found, the extremity of the ileum
fallen within the colon, concreted with the membranes of it, and contracted
lb as to prevent the progrefs " of a foetid liquor, almoft of the nature of cx-
u crement," with which the in all inteftines were feen to be " iurprizingly
M diftended," being attended with inflammation at the fame time.
Nor, finally, is that obfervation to be omitted, though made upon a dog,
which the celebrated Wahrendorff (Jj) has given us. This creature having
had no difcharge by ftool for fome weeks, had vomited up every thing he
took with miicrable howlings •, and having at length died, difcover'd no in-
flammation, or obstruction, in the inteftines, except that '• about the begin-
" ning of the inteftinum rectum, there appear'd an intus-fufception, to about
M the length of two inches, which fhut up the paflage fo compleatly, that
" not even the lead: flatus could be transmitted." From all thefe observa-
tions which I, according to cuftom, have taken notice of, in order that you
might have fome to add to the Sepulchretum, you eafily perceive, that an ob-
ltruction of the inteftinal canal, or a confiderable and long-continu'd coarc-
tation, has more effect towards producing a volvulus, than an inflammation ;
and that therefore an intus-fufception which does not caufe an obftruction, or
coarctation, as thofe that are flight, and eafily moveable, by no means do,
ought not to be attended to by us here.
To this clafs I refer thofe that I have hitherto happen'd to fee, and readily
acknowledge them to be of that kind, which an eminent author in anatomy
and furgery, of the prefent age, has afierted to occur in many bodies, who
died of a natural death, and who had been afflicted with no pain. But while
he afcribes fo much to the obfervations of this kind, as to fuppofe that the
doctrine of others, who have plac'd intus-fufception of the inteftines, among
the caufes of a volvulus, is a mere figment, I cannot coincide in opinion with
him, unlefs I would run counter to fo great a number of obfervations of
other perfons, that are contrary to his, and even run counter to reafon
itfcif.
For although I acknowledge, that it is not at all necefiary any very vio-
lent diforder fliould arife, where there is a lax fufception, that does noc
itreighten the paflage greatly, yet on the other hand, I maintain, that if the
fufception is not lax, and fhuts up the paflage for a long time together, or
at leaft nearly fhuts it up, a. volvulus, or pains, inflammations, and other
fymptoms of this kind, are the confequences, as you fee in the hiftories
which are pointed out in this fection of the Sepulchretum, under number
twenty, and in others, but particularly in thofe of Ruyfch (7), and in fome
of thofe befides which are referr'd to here, or above (k).
35. However, it is evident that a volvulus may be brought on, not only by
fufception, or by a hernia, or by an inflammation of the inteftines, but alfo
(g) Commerc. litter, a. 1745. hebd. 24- n* (') Obf. anat. chir. 91. & adverf. anat. decv
1. ad 1 1. 3. 5. & thef. anat. 10. n. 62. & alibi,
(/i) Ati. n. c. torn. 3. obi". 132, . {k) N. 32.
bv
■i6o Book III. Of Difeafes of the Belly.
by other caufes, which either obSruct, or Simulate them, as appears both
from the obfervations of others, and from mine alfo, which I (hall commu-
nicate to you on future occafions ; and from caufes that obSruct, neceffarily,
and unavoidably, provided life laSs for any confiderable time with them ;
but from Simulating caufes, fometimes only. And the obSructing caufes
often relate to the coats of fome intefline, as, for inSance, that Icirrhous
•ring fpoken of in the thirty-fecond letter (/) •, for Sercoraceous vomitings
were at length the confequences thereof: and, at other times, relate to the
contents of the inteftines, and not only to the hardened excrements, as in the
example related by Hoffmann (*»), where, being collected together, to about
the quantity of twenty pounds, they had fo diftended the colon of a certain
prince, who was afflicted w'kh the ileos, that they at length burS through it ;
but alfo, fometimes, to a calculous matter, which is gather'd about gall-
stones, or about gold coins, that have been fwallow'd, and which being fo
increas'd by their long continuance in the inteftines, has brought on the
fame diforder, by (hutting up the pafiage, and rendering it impervious : ex-
amples of which things, to pafs over thofe of others, you will find in the
books of the Caefarean Academy (»).
Moreover you will in thefe fame volumes, alfo, find inSances which you
may fet down to the clafs of Simulating caufes (o) ; as when a young man,
by a fall upon his abdomen, ruptur'd the bladder, and caus'd the urine to be
pour'd out into the cavity of the belly, fo that the inteSines being Simulated
by an unufual acrimony, which the inflammation, and gangrene, that was
the confequence of their inflammation, (how, inverted their periSaltic mo-
tion •, or when the abdomen of a full-grown foetus being bruis'd by a like fall
of its mother, was the reafon that blood Sagnating, and putrefying, in the
veffels of the inteSines, brought on equal effects therein, by irritation, for
the infant difcharg'd nothing at all from the rectum, but every thing, even
the meconium itielf, by the mouth, and died in a miferable manner within
eight days from its birth. Andif the Simulus excite convulfions, what they
are capable of doing, not only by producing fufceptions, as I have faid above
(p), but alfo without thefe by inverting the motion of the inteSines, the
experiments of Brunnerus (q) will (how-, I mean the grandfon, who was
worthy of his grandfire •, by which it appears that convulfions being excited
in the inteSines of beaSs, the excrements, which could not now be difcharg'd
through the anus, afcended into the Stomach and cefophagus. And a dif-
eafe which by reafon of its very violent tormina, and continual vomiting,
and by reafon of the large inteSines being unufually Sreighten'd, when the
lmall inteSines were very turgid, and red, and fill'd with a remarkable quantity
of extravafated, and fluid blood, is very fimilar to the volvulus, has been
accounted for by the celebrated Kulbelius (r), from fpafmodic contractions.
And whether it was from thefe fpafmodic contractions returning now and
then, or from the effect of them which remain'd, that the fame inteSines
(/) N. 5. (0) Cent. 7. obf. 30. &a&. t. 3. obf. 131.
(/•/») C. 4. paulo ante cit. §.13. (/>) N. 32.
(«) Aft. £. 7. obf. ico. St cent, 1 & 2. obf. (?) Experim. circa ligat. nerv. §.31.
J54. (.•) Commerc. litter, a. 1737. hebd. 20. n. 2.
had
Letter XXXIV. Article 36. 161
had fome parts which were unequal, and, at unequal intervals, prsterna-
rurally narrow, in that anatomift Jo. Wilhelmus Albrechtus, who, while lie
liv'J, was very often fubject to the iieos, you. yourfelf 'will judge (s),
36. But among the caules which fometimes bring on the iliac paflion by
ftimulating, worms mult of courle be enumerated. For fometimes, as is
hinted at above (/), by exciting convulfions. they caufe iutus-fufceptions, and
volvulus : and it is not to be doubted but they can excite a volvulus,
without caufing fulceptiolis. At other times they create pains in the
intcilines only. And fometimes not even thefe. And it alfo frequently
happens, that a great number of worms are found in thole bodies, in which,
while living, there had fcarcely been the leaft fymptom of worms : and
this you will lie fuliiciently confirm'd, by reading over again the hiftory of
the country-woman defcrib'd in the fixteenth letter (u), or what I formerly
wrote of the hound (.v), in which there were taeniae, to the number of
fixty. And, on the other hand, there are fometimes fymptoms of worms,
and none are found, as you learn from the hifbory of the boy given you
from Valfalva's papers, in the thirty -firft letter (y) ; and not to dwell too loner
upon an obvious thing, the fame will appear from another alfo, that is
related in the Sepulchretum (z).
But in regard to worms exciting pains of the belly, I fhall perhaps have
occafion to fpeak on this fubject, at another time, and to enquire more at
large, whether, as they irritate the inteftines in the living body, it is like-
wife to be fuppos'd in all the hiltories, which are produe'd to prove it,
that they perforated the inteftines before death, or rather that they per-
forated the inteftines after death, and if they did really pervade the in-
teftines before death, whether it was where an abfeefs, or fome kind of
ulcer, had open'd them a paflfage from the inteftines. For many and
various obfervations are produe'd : of which, however, it will be fuffi-
cient to point out fome to you, of thofe that you may add to the Sepul-
chretum. See firft two of thefe in the acts of the Cseiarean Academy (a).
In one of which, in proportion as the inteftines are faid to be more fill'd
■with an incredible quantity of worms, from the upper to the lower part of
that tube, it may perhaps feem to be render'd fo much the more credible,
that they, efpecially as they were inftigated by a quantity of bitter elixir,
had begun to perforate the inteftines in the living body, from which they
were already protruded by half their length. An equal, and even a greater,
quantity of worms was found by our Molinetti {b) •, for befides thofe, with
which all the inteftines were fill'd, and ftuff'd up, others had got out from
the inteftinal tube, which was perforated like a fieve, and fill'd the abdo-
minal cavity all around. But thefe appearances were feen in the dead. body,
as thofe alfo which I found in a hen (c).
But how is it when they are (cen in the living body ? A very ancient ob-
servation is extant of Hippocrates (i), made upon a little child of Dinius,
from whole navel, " a large worm fometimes" came out. But as a ;- fii-
(s) A. 1736. hebd, 12. n. 1. (a) Tom. 1. obf. 172. & torn. 5. obf. 68.
(/) N. 32. propenn.
\u) N. 38. (6) Diflert. anat. Pathol. 1. 6. c. 4.
(*) Epirt. anat. 14. n. 48. . (c) Epift. anat. 14. n. 44.
(y) N. 5. (z) Obf. i. §. 2. (d) Epid. 1. 7. haud ita procul. a fine.
Vol. II. Y " tula
1 62 Book III. Of Diieafcs of the Belly.
" tula" had been left there from a foregoing wound, and the worm and
bilious fordcs came through the fame place •, it was certain, beyond a doubt,
that the froall intcftine was perforated ; but it was from a wound •, for that it
was perforarcd by the worm, was not even fufpected by the grave interpreter
Vallefius (e). There is likewife extant; not to digreft improperly from
thofe obfervations which are join'd with the difTection of the body ; there is
extant, I fay, in the acts juft now quoted (f), an example of fifteen worms
coming out from the right hypochondrium, and the loins, on the fide that
correfponded thereto, yet through tumours which had been form'd in both
places, and fuppurated ; the origin of which is attributed to the worms, in-
deed, having gnaw'd the inteftinum colon, but at the fame time to a vitiated,
corrupt, and eroding faburra, which had been collected there. When you
read, therefore, in the fir ft (g) and feventh (h) centuries of the fame Caefarean
Academy, other obfervations of that kind •, although in the fecond, for the
lake of brevity, perhaps, no mention is made of any tumour, or abfeefs,
you will confider what any one might fufpect. For it is my intention here,
as I have faid, to point out the examples which relate to the various caufes of
pains in the inteftines, and not to enquire how, and in what manner, they
happen'd.
When we enquire into this, another thing, alfo, mud of courfe be en-
quir'd into, which the obfervation of Platerus (z), relating to the volvulus
likewife, affords us a handle for the inveftigation of, I mean whether worms
are viviparous. For he faw the inteftines of a boy, or rather of a young
man, furprizingly convoluted, twifted, intangled, and diftended, not only
with excrements, and flatus, " but alfo with living worms, oblong in their
t{ figure, and in great number, which were again fill'd with other lefTer
" worms." You will alfo read this obfervation iu the Sepulchretum, not
only in the fourteenth fection which we are at prefent upon (£), but alfo in
the twenty-firft (/), and you will the more attend to it, if you light on the
difiertation, in which the fkilful phyfician Zamponius defcribes to the cele-
brated Plancus, a worm which was difcharg'd by another boy, and which
brought forth, under his very eyes, foon after, many fmall living worms to
the number of eight and twenty. But all thefe things relate to the round
worms.
37. For as to what I remember to have read of the teniae, and afcarides,
juft as if they perform'd the office of ovaria, or rather of a uterus, to the
others ; either 1 am much deceiv'd indeed, or the queftion is of fuch a na<-
ture, that makes it very needlefs for me toconvafs it, as this alfo is, whether
" the taenia; are afcarides, that are mutually join'd to each other," efpccially
as they who affert it, confefs, " that the afcarides are lodg'd only in the in-
" teftinum rectum," and in like manner, whether the afcarides " are worms
proper, as it were, to the human body •, whether other fpecies of worms are-
" very rare," and other queries of the like nature, which, in my opinion,
ought to be interpreted differently, as they, at the very firft fight, feem to .
fliow.
(f) Comment, in eum. 1. n. 105^ (/) L. 3. obf. ubi de extuberantia. .
(/) Tom. 6. obf; 93.. (i) Subn. xxi. §. 1.
(g) Obf. 39. (/) Sub n. xxii. §. 4.
(b) Obf. 7.
At
Letter XXXIV. Article 37. 163
At lead Vallilheri :'/;;) did not doubt but the taenia was made up of vermes.
eveurbitim, worms which he thus call'd in common with others, and which laid
hold 01" one another mutually, ufing among others the tinnle, that I fee even
Homer had made ule of formerly (n), for another purpofe; 1 mean that of
bats, which hanging from a rock, in the recefs of a great cave, are mutually
held by each other. But I have often wonder' d that the opinion which Val-
lifneri patroniz'd, could not be confirm'd by me, in fo many teniae which I
have accurately inlpected, and examin'd, and thefe taken from quadrupeds,
fifties, and birds : and thus you will eafily perceive, if you read attentively
the oblervations which I have publifh'd, in the fourteenth of the Epiftolas
Anatomicae (o) ; anil even if you read that which Vallilheri formerly publifh'd,
with my letter which was written to him (p) : from which obfervations, ic
will rather feem to you to be gather'd, that each of thele teniae are diflincl
long worms, than a concatention of many. But now I have ceas'd to won-
der, fince I have learn'd that by the induftry of the celebrated Window, a
duel is, at length, found out, and clearly prov'd, by an injection of a very
fluid matter, which went through the whole length of the tenia.
If this duel had been known at the time in which I, or Valiifneri, wrote,
and the experiments had been publifh'd, by which it appears that aquatic
worms, divided into many parts, had liv'd about three months, without any
nourifhment •, and, by a new obfervation, it had alfo been made probable, in
another fpecies of teniae, that in the very flender extremity, which feem'd to
be the tail, was the head of the tenise •, not only I fhould more readily have
underflood what I faw, but he would have fought out other arguments to
fupport his opinion, or rather, as he was a man very ftudious of truth, would
have entirely difcarded it.
But thefe things that I have mention'd, have come forth fince that time, as
you will learn from the difTertation, of the very experiene'd Bonnet, upon the
tasnia, which is written accurately, learnedly, and ingenioufty, and which
was preiented to the Royal Academy of Sciences at Paris (a). This difTer-
tation will perhaps furnifh us with an occafion of enquiring into other things,
at fome future opportunity. But now, ftill keeping my fubject in view, I
return from thefe difquifitions, which came accidentally in my way, to my
original intention, as I fee that fome things flill remain, out of thofe which
relate to pains of the inteflines, which deferve confideration, and are defin-
able to be known ; but as this letter is already very long, I fhall defer what
remains to be faid on this fubjeel, to the next. Farewell.
{m) Confideraz- int, alia generaz,. de vermi (p) In cake modo cit. libri.
&c. \q) Memoires prefentes a l'acad. r. des fc.
(«) Odyf. 1. 24. lub iniuum. torn. 1.
(0) N. 47. ufque ad 55.
X i LETTER
1 64 Book III. Of Difeafes of the Belly.
LETTER the THIRTY-FIFTH
Concludes the Difcourfe upon Pains of the Inteftines.
IT is true that I have compris'd in the laft letter, a great number of ex-
amples of pain in the inteftines, and of the inflammation and gangrene
that are the confequences of it. Yet other examples (till remain, which fo
n uch the more deferve attention from you, and other junior phyficians, as
you will find that the patients were fnatch'd away in a fhorter time, or un-
der a more deceitful appearance of remifiion. I fhall begin with thefe of the
firl' kind, and even with the cafe of a young man, who was extremely well-
known to me, when I was at Bologna, and whole difeafe was fo rapid in its
progrefs, that I had fcarcely heard of his diforder before I heard of his death.
And the following is the narration of the cafe, for it was not written by
Valfalva, but deliver'd to us from his own mouth, at the time in which it
happen'd.
2. Laslius Laelii, a native of Imola, in the papal territories, a ftudent in
medicine, was a lover of folitude, and by nature eafily irafcible: this young
man, when he was in good health as ufual, without any previous caufe, ex-
cept that he knew his father was then at the point of death, and expected,
every hour, the melancholy news of his having actually expir'd, was fud-
denly feiz'd, about the fourth or fifth hour of the night, in the middle of
November, in the year 1705, with a violent pain in the umbilical region,
which fometimes was moil troublefome in one part, and fometimes in the
other, but never went out beyond fome certain fpace of that fame region.
The perfon with whom he lodg'd being wak'd by his cries, gave him, accord-
ing to the advice of fome neighbouring phyfician, a dofe of Philonium Rcma-
num. This was thrown up by vomiting •, for he had already begun to vomit
aporraceous bile, which afterwards became seruginous, and at length, when
he v\as near death, black, yet flill fo as to be inclin'd to a feruginous colour.
In the noming, about ten hours after the beginning of the pain, Val--
falva was call'd to the patient. Who, obferving an unpromifing afpecl in
the face, an abdomen tenfe, and painful to the touch, a low, and as it were
conitricted pulfe, which could hardly be felt, a urine of a red colour dege-
nerating into brown and extremely turbid, aid orher things of this kind,
and feeing that fo much mifchkf was done in fo fhort a time, and calling to
mind other observations of his, of diforders not much unlike this, pro-
nounc'u
Letter XXXV. Article 3. 165
nouncM that he would die within the fpace of twenty four hours. Yet that
the patient might not be immediately fenfible of this, he order'd frefh-
drawn oil of almonds to be given internally, and the belly to be anointed
with oil of violets, with the addition of camphor, and two fen tor phyficians
to be fentfor. Thefe gentlemen coming four hours after, he laid to them, you
will fee a young man, a worthy-fellow citizen of mine, ltruggling with fo
oppreflive a diforder, that unlefs you can adminiller fome relief, I fear he
will not be able to bear up under it long ; for, in regard to myfelf, I ingenu-
oufly confefs, I do not lee wherein I can afltlt him. At the fame time he re-
lates the cafe, and introduces them to the patient.
After having examin'd into the fymptoms, it was their opinion that he
was opprefs'd by a convulfion, and that, therefore, blood mould be taken
away from his foot : and that a large cupping-glafs fhould be fix'd to the
abdomen. Valfalva was averfe to the idea of blood-letcing, but as he de-
liver'd his opinion with modelty, he was overcome by the. contrary opinion
of the fenior phyficians. A vein was twice open'd : from the firft orifice no
blood at all came-, from the fecond, blood did, indeed, fpring forth, but im-
mediately loft its impetus, and came out in fo languid a manner, that al-
though the orifice was foon after tied up, the pulfe could no more be per-
ceiv'd. A flight delirium afterwards came on : the eyes fliow'd fomething
of a convulfive appearance : the refpiration became difficult : and, finally,
death came on, according to the prediction of Valfalva, in the following
night.
Valfalva, when he put his hand on the abdomen of the carcafe, perceiv'd
that there was an extravafated humour in that cavity. It was a fluid blood,
which had been effus'd to the quantity of about a pound and half: and
fome blood was alfo extravafated into the bronchia. However, in the belly
was a ftrong fmell, but not to a very great degree. The interlines were, in
a great part of them, red in feveral places, efpsrcially rhofe which lay upper-
most in the abdomen ; and the ileum had already begun to be livid. The
peritonaeum was mark'd with black fpots, in feveral places, but particularly
where it inverts the diaphragm. But where it cover'd the ftomach, which
had a natural appearance on the internal part, it was unequal with black
tubercles, rather than with fpots. And thefe tubercles, although at firft
they had the appearance of glands, were in fact (for- Valfalva himfelf fliow'd
them, and I faw fome of them foon after) nothing elfe but a stagnating
blood, or, if you pleafe, rather the beginning of a gangrene.
3. When he had fliown me thefe appearances, and, at the fame time, re-
lated the cafe, as I have defcrib'd it to you, I afk'd him why he had neither
prefcrib'd bleeding himfelf, nor approv'd of it when others prefcrib'd it ?
He anfwer'd, that he had no reafon at hand, which would clearly fatisfy me ;
but I have, fays he, obfervation. For I have remark'd that blood-letting
does not fucceed well in inflammations of the bowels : and indeed I have
even often obferv'd, that patients, of themfelves, become exceedingly bad of
a fudden in that diforder, and contrary to expectation, fo that I am afraid to
make ufe of any remedy of this kind, left the blame .fhould be laid upon the-
remedy, which ought to be laid upon the very nature cf the diforder.
X. WI- at
1 66 Book III. Of Difeafcs of the Belly.
What then, you will naturally fay, when you read this, If any one is
almoft loaded with a quantity of good blood, if his conftitution is ftrong,
and firm, and he be feiz'd with a very violent pain in his inteftines, mutt we,
upon the authority of Valfalva, omit to take blood from him ? What is
this but to fuffer an inflammation to continue, which it would be eafy for
you to prevent ? What! If the pain is from a convulfion, muft we not en-
deavour to counteract this by bleeding, but muft we even fuffer the vefiels
to be the more dangeroufly contracted, in proportion as they are more full ?
Softly, I befeech you •, for who has told you, that in fuch a man as you de-
icribe, Valfalva would not have immediately taken blood away ? For it is
quite a different thing, to open a vein before an inflammation is form'd, or
even while it is beginning to be form'd, and efpecially in a conftitution of
this kind, from what it is to take blood away when the inflammation is
already form'd, when the ftrength of the patient is diminifh'd, and every-
thing is in a very critical fituation •, or in other words, to run the rifque,
as Celfus fays (a), " of feeming to have kill'd the patient, " who muft
have funk under his own fevere fate." For the courfe of this difeafe is of-
ten more fpeedy than we mould fuppofe •, fo that if you regard the hours,
you" would think it in its beginning, even at the time when it has done all
the mifchief in its power, and is hastening to its fatal conclufion : wherefore
in this diforder, if in any other whatever, that Hippocratic maxim (b) is true,
cccofio praceps : for fhort indeed is the opportunity of relief. There had
been this opportunity in Lselius, during the firft hours of his diforder, when
the philonium was rafhly, not to fay to no purpofe, advis'd. When Valfalva
came to him, this opportunity was pafs'd, and ftill more when the fenior phy-
ficians were call'd.
4. For as to their thinking, from thefe very fymptoms, by which Val-
falva judged the young man to be overcome with the force of a diforder,
which was already become infuperable, that he was opprefs'd by a convulfion,
•which they bcliev'd to be as yet moveable •, without doubt the fuccefs of
venae fection, fhows plainly, which opinion came the neareft to truth.
I confefs, however, it cannot be denied, that in this diforder convulfion
has frequently a great fhare, and this convulfion is fo much the greater, in
proportion as the pain is more fevere, whether the pain excite the convulfion,
or is excited by the convulfion, and alfo in proportion as it makes the greater
fpeed to its fatal termination. Thus I underftand why Boerhaave (c) has
accounted for the exquifite fenfe of the inteftines, from their great number
of nervous papillae, and immediately adds : " wherefore perfons are very
" foon deftroy'd by inflammation, and excoriation of the inteftines, and if
" there be a very great violence of pain, the ftrongeft man is difpatch'd in
" the fpace of a fingle hour." But frequently, alfo, in a violent pain of
the inteftines, manifeft marks of convulfion difcover themfelves, even more
than in Laslius (d).
Thus, not to mention here the horrid convulfions, that are defcrib'd in
an obfervation (*), which, whether you confider the fymptoms, or the dif-
(«) De medic. 1. 5. c. 26. (</) Dc quo fupra n. 2.
(b) Seel. 1. aph. 1. \e) Eph. n. c dec. 3. a. 7 & 8 obf. 145.
\c] Praleft. ad inftit. §.91.
fection,
Letter XXXV. Article 5. 167
fection, certainly relates to the preient fubject ■, thus, I fay, I remember a
virgin in the place of my nativity, pretty far advane'd in years, but of a
ftrong constitution, who was fubject to a pain in the bell}', which her fenior
phyfician did not doubt was a colic, and who, being feiz'd with the fame pain,
but more violently than ufual, about the end of the year i 709, yet without any
fymptoms of fever attending it, whether you confkler'd the pulfc, the urine,
or any other marks, was very much eas'd by a gl viler, which had brought
away a bilious matter, and her dilbrder grew milder every clay, fo that llie
was no longer vilited by her phyfician •, I remember, therefore, that when
the women, who attended the patient, had, inflcad of a glyfter, which had:
been injected every other day in the evening, introdue'd a fuppofitory of
honey, file was immediately feiz'd with fo violent a pain in the anus, that in
the morning no pulfe could be found : and that with this pain, wasjoin'd
ib great a conibiction of the anus, that a glyfter could by no means be in-
jected : but foon after, when they endeavour'd to cure this contraction, and
pain, by emollients, and anodynes, I remember that all of a fudden, a re-
laxation of this part came on, juft as it frequently does in bodies after death,
and about noon, death itfelf.
Suppofe then, that this diforder was a convulfion. And will you fuppofe
it could have been eafily remov'd by blood-letting ? What if fuch a caufe
vellicate the nerves, as it is very difficult to overcome, or if it can perhaps be
overcome, for a very fhort time, it foon after attacks the patient in a more
violent degree, as is frequently the cafe in convulfive diforders ? Attend to.
what happen'd when I refided at Bologna. There was a monk, who was an.
old man indeed, but very ftrong. This man was feiz'd, of a fudden, with-
out any evident caufe, except, perhaps, from cold, and fatigue, with a pain
in his belly, which was fo violent that he could not ftand in any one place,
and was fore'd to cry out. Oil of almonds was given to no effect, glyfters
were injected without the leaft advantage, and blood drawn from the foot..
No remedy being of any ufe, he died within twelve hours at leaft, having
gnafh'd his teeth two or three times.
I do not write thefe things againft blood-letting, which, if you ufe it in
time, is a very uicful remedy. But I put you in mind of what may foon
happen, in diforders of this kind, even after that remedy has been made
ufe of, when very violent convulfions prevail : and this that you may know,
yourfelf, and previcufly inform others, that an important remedy is not to
be rafnly blam'd, if it happen that a fatal termination of the difeafe foon
follow its ufe. But as, whatever previous admonitions are given, it is al-
ways a reproachable calamity with moft perfons, if a fpeedy death fucceed a
considerable remedy that has been made ufe of, you plainly underftand why
Valfalva was afraid of the ufe of remedies of this kind, in thefe difeafes.
5. But what if the diflection of the body take away all excufe from the phy-r
fician ? For a convulfion, although it does not return, may neverthclefs have
brought on fuch a dilbrder in the inteftines fuddenly, and contrary to exr
pectation, by obftructing the blood in the conftricted vefTcls, that during this
constriction blood cannot be taken away with propriety. You have feen, in
the cafe of I^a;iius, how foon the inteftines had not only contracted an in flam-
5 mat ion; ,
1 68 Book III. Of Difeafes of the Belly.
mation, but a lividnefs likevvife. No part perhaps, more eafily, and fooner,
than the interlines, degenerates into a gangrene, and becomes black, with-
out the phyfkian's fulpecting any thing or that kind. Which, although 1
could ftill more properly demonltrate it by hiitories that are elfewhere pro-
due'd, or will be produe'd in this letter (f) ; yet I v/ill alfo (how here, by
two oblervations that I receiv'd from my two preceptors, the one from Val-
falva, and the other from Jacob Sandri. And fir-ft take this from Valfalva.
6. There was a man, who for fome months, at leaft, had been ieiz'd every-
day, five or fix hours after eating, with pains of the belly, as if he were torn
by dogs. To this was added a Tlux of yellow matter, and a waiting of flefru
when, of a fudden, he was attack'd by an apoplexy, which was flight in-
deed, and after a day or two feem'd to remit, fo that his hands recover'd
fome power of motion, and his fenfes were lefs opprefs'd : yet he died on the
fifth day.
His body being examm'd, every thing appear'd. to be found, if you ex-
cept the brain, and the inteftinum ileum. For in the ventricles of the for-
mer, was a large quantity of ferum, from which the plexus choroides had
become pale. And in the ileum were feven or eight annular fpaces, and thofe
of a black hue : in which fpaces were glands of the bignefs of a vetch, and
moft of them fill'd with a white matter: thefe glands were not collected into
-heaps, nor plac'd on the internal furface, but were fcatter'd abroad diftinctly
from each other, and were rather prominent betwixt the coats of the in-
teftine.
7. The caufe of the apoplexy, as it does not relate to the prefent fubjedt,
being fet afide,you fee that the caufe of the pains which recurr'd everyday at
a certain hour, confided, without doubt, in the enlarg'd glands of the ileum,
whether they, as Valfalva thought, by what he had feen in fome other in-
ftances, could not bear the p refill re of the nutritous matter, as it pafs'd
through the inteftine, without pain •, or were diftended by the new
chyle, which was unable to ftruggle through the narrow paflages of thefe
glands, that were in part obftructed : which both the nature thereof, that to
Valfalva feem'd not unlike that of the glands in the mefentery, fbow'd •, and
that white matter with which moft of them were fturr'd up, in fome meafure
confirm'd.
But what I would have you principally attend to here, is, how eafily, and
how foon, all thefe fpaces, in which they were, contracted a blacknefs. But
you will fay that the apoplexy had increas'd the inertia of the fibres of the
inteftine, and prevented them from difpatching the blood with fo much ce-
lerity, through thofe fpaces, which were vitiated by the glands. I confeis
it: but a gangrene is not us'd to feizc upon other difeas'd parts fo foon,
when an apoplexy comes on. And certainly no apoplexy had preceded in
the other obfervation, which Sandri related in tire following manner.
8. N. Cupellini being afflicted with a colic difcrder, was fitting down
on a chair, and drinking an emulfion, when, all of a fudden, he faid to his
fervant, who was {landing by him, take it, ftretching out, at the fame time,
rhe glafs which he held in his hand ; and as he faid this, he fell backwards,
•
(f) N. 16. & 18.
and
Letter XXXV. Article 9, 10,11. 169
and died in an inftant. The whole body being examin'd by difTe&ion, no
diforder was found, befides an inflammation of the inteftinum colon, which
inclin'd to blacknefs.
9. From this observation you not only fee what T advane'd, but alio per-
ceive what diforder there certainly might be in the lame intefline, in the
virgin of Forli, alfo, of whom I fpoke jufl now (g). And I would not
have you be furpriz'd that there were no previous fymptoms of a fever ;
as we are about to fee in this very letter (£), whether there can be an in-
flammation without a fever, and even whether there can be a fphacelus with-
out an inflammation. But we mull firll confider fuch things as relate to the
celerity, with which the inteltines contract a fatal inflammation.
10. A certain running footman (that is to fay he whom I have taken
notice of in the fifteenth of the Epillolas Anatomicas (/'), where I wrote
other things of him, which I fliall not repeat here) of a low ftature, and a
fat habit of body, being no longer able to do bufmefs as a fervant, beg'd for
his livelihood fome years, and made very plentiful ufe of wine, when he
could get it. Wherefore even on the laft day of his life, when he came home,
and laid that he was not well, he took nothing to cure himfelf but bread and
wine, loon after which complaining of pains in the belly, he died with them
about midnight. His body was brought on the day following into the col-
lege, where about the beginning of February, in the year 1736, I taught
anatomy.
The mufcles of the abdomen, which were lax, being cut into, and the
belly, from whence a very ilrong fmell proceeded, being laid open, I faw
that a very confiderable part of the fmall intellines went down, to a" confider-
able depth, into the lower part of the pelvis, fo as to reach quite to the con-
junction of the bladder with the rectum, filling up all the fpace that was
there. But that appearance had exifted from the original formation of the
body, or at leafl was not recent. This however was recent, that thefe, and
the other parts of the fmall intellines, were, in fome places, extremely nar-
row, and, at the fame time, brown, but in other places red, even the fmalleft
vefiels being fo much diltended from the Stagnating blood, that it almoft
feem'd as if they had been fill'd with an injection of red wax. And the fame
appearance was feen in feveral parts of the large intellines, but efpecially at
the beginning of the colon. The edge of the liver was blackilh. The fpleen
was larger than it naturally is. The trunk of the great artery, as it pafs'd
through the belly, was not free from fome little offifications. And the vena
cava was fill'd with much fluid and black blood.
11. It is true it was not fo fhort a fpace of time, in which the inflamma-
tion of the intellines carried off the woman, of whom I am to write next :
yet it was fhort, and perhaps fhorter than it feems, if it were as certain when
the inflammation began, as it is when fhe firfl began to be diforder'd at all.
But although this is not fo clear, yet the other remarks that I made upon
this woman, I mult not pafs over here, as I promisM them when I wrote of
(g) N. 4. (/) N. 70. ad fin.
(b) N. 19. & feq.
Vol. II. Z the
170 Book III, Of Difeafes of the Belly.
the palpitation of the heart (£), and of the pulfe'(/), and even when I
treated of the affections of the eye(m). For this is the old woman, whole
diforders I defcrib'd in that place, only as far as they related to her eyes,
and defer'd the remaining part of the defcription to another occafion.
12. A poor old blind woman, of a fmall and fiender body, having been ill
for three days, was brought into the hofpital at Padua, being fuppos'd to
labour under an inflammation of the thorax. For from the patient herfelf
nothing certain could be learn'd, as fhe was then very weak, and her pulfe
fo very low and fmall, that fhe was carried out dead, on the very fame day fhe
had been brought in. This woman's body, as the time of the year was fuit-
able, for it was about the beginning of the year 1742, was more ufefui than
I expected, in order to demonftrate many things to the ftudents. And in
the courfe of thole demonftrations, I lit on thefe morbid appearances, which
I fhall take notice of.
In the belly the inteflines were inflam'd, as the liver was alfo. And to
the fame caufe it was to be afcrib'd, that when the uterus was open'd, the
Internal furface of the fundus was of a colour not lefs red, than if the woman
had lately menftruated. But where the fundus contracted itfelf into the
cervix, and the anterior and pofterior internal furfaces came together, and
form'd an angle in the right fide, a membrane proceeded from this angle, not
very fmall in its fize, and pafs'd tranfverfly to the pofterior furface, univer-
fally cohering with that furface, on its inferior border, but being, in other re-
flects, loofe and floating, fo that, contrary to the ufual appearance of the
valvulae cervicis, it had its cavity turn'd upwards, and not downwards : for
which reafon I fufpected that this had not exifted from the original formation,
but had, perhaps, been the confequence of a difficult birth ; for it was cer-
tain the woman had brought forth children, and I faw the uterus inclin'd to
the right fide.
In the thorax the lungs were perfectly found. But the pericardium was,
on all fides, connected to the heart, by a univerfal, though not very firm co-
hefion, fo that the two membranes, that is of the heart, and pericardium, could
eafily be disjoin'd from each other, by dividing thefe connections with the
fingers, and without lacerating either. The pericardium did not adhere to
the great veffels : but on the furface, by which it had adher'd to the heart,
appear'd a certain white fpot, only in one place, and that extending itfelf to
a fmall breadth only. In the ventricles of the heart was fome blood which
was black, as indeed the blood was every where, but there were no poly-
pous concretions in thefe cavities. Yet in other parts of the body thefe con-
cretions were found, round in their figure, and white, and fome thick, firm,
and long, as thofe were which went from the right auricle, to the internal
jugular veins, and thofe, alfo, which were produc'd from the orifices of the
heart into the arterial veffels. Finally, what appearances were found in the
eyes, I have already faid in that letter which was laft pointed out.
13. Although the hiftories which I have hitherto given you, fhow how foon
pains of the inteflines may, fometimes, become fatal, either by the force of
inflammation, or even of convulfion ; and confequently, how cautious aphy-
(£) Epift. 23. n. 21. (/) Epilt. 24. n. 12. («) Epift. 13. n. 17.
fician
Letter XXXV. Article 14. iji
fician ought to bo, and even fuipicious, during the violence of this difeafe :
yet that he ought to be much more cautious, and fuipicious, left he mould,
at any time, be deceiv'd into a vain hope by the iteming remiflion, and, as
it were, departure of thisdiforder, the following dbfervations will fhow you.
14. A young man who was much given to the ufe of wine, and fpirituous
liquors, as they are call'd, having labour'd under an intermitting fever, not
long before, was feiz'd with a pain of the belly, which a difchargc of flatus,
downwards, remov'd. However, after fome days, the pain return'd again ;
which not being able to get rid of at home, he was, at length, receiv'd into the
hofpital of St. Mary de Vita at Bologna, on the fixth day after the return
of his pain. The pain was continual in the hypogaftrium, but flight, ex-
cept that it now and then increas'd, and the belly was often, at thefe times,
more fweli'd in that part, and if you applied your hand to it, you perceiv'd
many hard globules, as it were, feated in that region. But all thefe fymp-
toms foon vanifh'd ; yet return'd again, at intervals. The ftomach alfo
was painful, and he now threw up all his aliments by vomiting, as well as
his medicines, among which was even opium itfelf.
Wherefore, as the inteftines difcharg'd none of their freces, but by means
of glyfters, it was determin'd to pay a regard to this circumtlance and, at
the fame time, to inject fomething of a curative and nutritious nature in
the glyfters, as broths, for inftance, and decoctions of emollient herbs, but
this was done without any alleviation of the pains, fo that no excrements
were brought away, before linfeed oil had been more than once thrown up.
Unctions of the belly with the fame oil, and others, were, alfo, tried without
effect. The patient bore the pain better when he fat up in the bed, than
when he lay down, for which reafon he fat up even when he flept. He was
alio better, and flept better, with an empty ftomach, than if he happen'd to
keep any thing down : which circumftance, and the abfence of fome other
fymptoms, that frequently fhew the exiftence of worms, made us fuppofe
that the pain did not arife from worms, notwithstanding he had thrown up
one very long, and round worm, from his mouth, three days before.
At laft he began to retain fome of his nourifhments, and even his dinner
alfo. His cheeks were red, which he himfelf faid was owing to a defluxion
of humours on his face, to which he had been fubject. He was thirfty. His
abdomen was univerfally diftended. It was now the fifth day from the time
of his coming into the hofpital, and I fpoke to him, as ufual, about the fix-
teenth hour, for the winter of the year 1 703 was coming on : he faid that ho
was a little better, which was conhrm'd by his countenance, and alacrity of
fpeech, and by a more firm vigor of the body, in fitting •, for the pulfe ne-
ver had had any difagreeable fymptom, nor had even then : at leaft there
was no fever, nor could any ever be obferv'd, during the whole courfe of his
being in the hofpital, except, perhaps, once. And from this ftate of the
diforder who could have fuppos'd that any thing fo fatal was at hand ? Yet
fcarcely two hours had pafs'd, from the time that I, and the ftudents who
faw him with me, had made thefe obfervations, when he began, of a fudden,
to cry out from a feverity of pain, and that continually even to the ninth hour
of the night. In the mean while he had a vomiting, and in the evening he
himfelf gave notice that his pulfe could no more be felt, nor indeed could it
Z 2 be
172 Book III. Of Difeafes of the Belly.
be perceiv'd, by thofe who were prefent. When it was the ninth hour, to
which time, as Ifaidjuft now, his pain continu'd, he faid that he mud orer.
out of bed, in order to have a ftool. And while he was about this bufinefs a
fwooning came on, and he died, in this manner, within half an hour.
While his body was wafh'd, on the day following, a great quantity of pu-
trid blood, as it were, flow'd out of his mouth, diluted with a ftercoraceous
fluid, of the colour of tobacco, and fmelling very ftrongly. And by this means
the abdomen became fomewhat flaccid in the hypogaftrium: and although
in the epigaftrium, which was livid, and in the other parts, it was (till
hard, and diftended, yet it was lefs fo than it had been in the living body.
When the knife penetrated to the cavity of the belly, a great quantity of
fluid immediately burft forth with an impetus, being fimilar to that which had
flow'd from his mouth ; and it burft forth in fuch a manner, that it was
doubtful, not only to us who flood by, but even to the perfon who per-
form'd the direction, whether it came from the cavity of the abdomen, into
which it had been before extravafated, or from the diftended inteftine, which,
in confequence of its diftention, might eafily be wounded together with the
peritonaeum.
However, foon after, when the abdomen was fully laid open, the cavity
thereof appear'd to be full of that humour. The fmall inteftines were all as
black as a chard-coal. And the fpleen, alio, was affected, or at leaft in
part, with the fame fphacelus. Yet the ftomach, as far as could be judg'd from
the external appearance, was found, and all that part of the large inteftines,
likewife, which goes from the termination of the ileum, to the left hypo-
chondrium : for we were prevented from inquiring into other appearances, by
the almoft inconceivable ill fmell •, which was fo much the greater, as through
negligence, and hafte, the inteftine had been perforated, whereby the filthy
proluvies was increas'd, with which a round worm, of a moderate fize, had
alfo come out.
15. You have feen how much diforder there was in all the fmall inteftines,
when the young man feem'd to be better. But do you imagine this mifchief
was done before he came into the hofpital, or afterwards ? If before, then of
courfe this very great diforder lay hid for five days, without thofe fymptoms
which generally attend upon a fphacelus. And if you fuppofe it to have hap-
pen'd afterwards, how did it all come on without figns of inflammation, and
particularly without a continual fever ? And fuppofe that almoft the fame
queftions may be afk'd you by me, when I produce the obfervations which
follow, or when you read that of Segerus, which is extant in this fourteenth
fection of the Sepulchretum («). That is to fay, an old man after having
complain'd, for fome days, of pains in the belly, to which he was fubject,
yet not fo violent, as to confine him to his bed, at length returning home
about evening from his garden, his pains became fo violent, that no remedies
were of fervice to him, and he died, on the following day, about the fourth
hour in the morning : and indeed other difeafes of long ftanding were found
in the pancreas, the liver, and the fpleen j but this one was recent, that
(,/) Obf. 6.
" the
Letter XXXV. Article x6. 173
*' the inteflines, particularly the fmall ones, and the colon, were very
" black."
Is it poflible then that all this mifchief could happen within a few hours, from
the time that Segerus had found the pulfc to be fomewhat more quick than
uiual ? But in regard to this I will alio confider below (o). At prefent, to return
to our young man, it" it had been certain that the very foetid colluvies, which
I have mention'd, had bcea previously efius'd into the cavity of the abdo-
men, by a rupture of the intettine while living, and not from a wound cf
the inteftine after death, as we had fome reafon to fufpect, we mould then
conjecture that the fwooning, and death which was the confequence of it,
had probably happen'd at the time when in the (trainings to difcharge the
faces, he had broken through fome rotten part of the diitended interline. For
Wepfer, alio, as you will likewife read in this fectionof the Sepulchretum (p),
fpeaks of " the inteftines being ruptur'd, and all the fordes extravafated into
" the cavity, with the fudden death of the patients." Which, however, does
not always necefiarily follow, as two obfervations in the fame fection of Fer-
nelius (q), and Riverius (rj, jointly demonflrate : and the fame may be ga-
ther'd from one of ours defcrib'd in the former letter. But whether thofe
which you read in the Commercium Litterarium (i), and in the Acts of the
Cadarean Academy (/), belong to one, or to the other clafs, I leave to your
own prudence to determine. To the former clafs, however, belongs that
which was lately given us by the celebrated Galeati (it) ; lb fuddenly was the
man carried off by tormina of the inteftines, and fo full of excrements was the
abdominal cavity, likewife, found, which had been difcharg'd from the rup-
tur'd inteftine.
But now let me give you a lamentable hiftory, in which the pains had not
only remitted, but entirely gone away.
16. A flender woman of a fhort ftature, and of a bilious temperament,
as it is call'd, being about forty years of age, and having been a widow for
three years, was accuftom'd to fpit blood now and then, which fhe attribut-
ed to having been without her menftrua, for eight years pad, though to me
it feem'd that this blood came from the larynx rather than from the lungs,
when, at length, from anger, and uneafinefs of mind, fhe was feiz'd with a
pain, on account of which fhe was oblig'd to come into the hofpital of St.
Mary de Morte, at Bologna, about the beginning of March, in the year
1706. This pain feem'd to be from the cutting of knives, as it were, firft be-
low the left breafl, from which feat it extended itfelf, afterwards, without
quitting it, to the part below the right breaft, where it was more flight how-
ever, fo as to fuffer the patient to lie on that fide. For it increas'd from the
part being touch'd : and made refpiration difficult. It had begun with a fe-
brile rigor, which recurr'd every day ; but the fever did not intermit. The
face was red: the thirft was troublefome ; but the cough ftill more fo, as it
exafperated the pain. The fpitting was frequently bloody, at other times
white, thick, and frothy. There was often a fenfation as if of fomething
(0) N. 19. & feq. {j) A. 1742. hebd. 45. n. 2.
(/) In addit. obf. 3. (t) Tom. 8. obf. 47.
(q) 23 & 21. §.4. (,/) Comment., de bonon. fc. acad. torn. 3.
(r) N. 9. inter medjea.
afcending
174 Book III. Of Difeafes of the Belly.
afcending to the throat. And, finally, there was a pain about the navel,
juft as if dogs were tearing that part. The belly was lax.
Blood was taken from the foot: and other remedies, which were fuppos'd
to be ferviceable, were adminifter'd. After a few days, without any previous
critical evacution, all the fymptoms were grown fo much milder, that the
phyfician pronounc'd the patient already well. In confequence of this (he
got out of bed : but her ftrength foon failing her, me was prefently oblig'd
to return to her bed, where (he was found contracted into herfelf, as we ge-
nerally are from cold, and without any pulfe. She was afk'd whether me
felt any pain in the thorax, or belly, to which fhe anfwer'd in the nega-
tive. On the fame day fhe began to difcharge a foetid blood by ftool. She
was afterwards delirious : and convulfive ftartings of the tendons difcover'd
themfelves in the wrifts. Being much weaken'd by thefe fymptoms, fo that
me was no longer able to fpeak, fhe died on the fixteenth day from the be-
ginning of the diforder.
The abdomen which had fubfided, being cut into, and laid open, a foetid
fmell was difcharg'd, fuch as generally comes from a gangrene, but mix'd
with that odour, which where there are worms feems to be emitted from an
acid matter as it were. Nor indeed were round worms wanting in the fmall
interlines, all of which, from a red colour, inclin'd to a livid and blackifh hue.
The fame morbid lividnefs occupied the flat furface of the liver, on the
lower part of it, and penetrated pretty far into its fubftance. The pancreas
being become thicker than natural, confided of indurated globules, as it
were. The liver, alfo, was fomewhat hard, and the gall-bladder was di-
ftended with calculi, to the number of a hundred and twenty, which were
contain'd in a palifh bile.
The largeft of thefe, which were about twenty in number, were equal to
the bignefs of a filbert. Other circumftances relative to thefe calculi, I have de-
fcrib'd in the Adverfaria, in the firft place (x). Where (y) fomething is alfo
faid of the fituation of the uterus in this widow, which was fo drawn to the
right fide of the pelvis, by the round ligament being fhorter than ufual,
that the middle of the pelvis was without a uterus. Moreover, where the
tube emerg'd from the uterus, on the left fide, was a prominent puftule,
turgid with a white pus, equal in fize to a lupin ; and the fubftance of the
uterus, which the puftule had hollowed out, appear'd to be black after the
puftule was open'd, and the pus difcharg'd. The tubes contain'd a matter
which was not white, but of a flefhy colour degenerating into yellow. The
teftes were contracted, and had a few veficles within them ; and the coat of
one was almoft cartilaginous.
On opening the thorax, we found the lungs, on their anterior furface,
connected in a few places to the pleura by membranes, but in other places
free, and found alfo, if you except the anterior part of the right lobe, the
fubftance of which was fomewhat compact, but not very hard. There was
no moifture in the pericardium: but in the right ventricle of the heart, which
was flaccid, and at all the orifices of that vifcus, were fmall polypous con-
cretions.
(*) III. animad. 28. (y) IV. animad. 25.
As
Letter XXXV. Article 17. i75
As to the parts or' the pharynx, from whence the bloody fpitt'ng had pro-
ceeded, I have fpoken or thefe in the Epilloku Anatomicx (2).
Finally, when the head was fever'd from the peck, a lmall quantity of
water i filled forth, through the great foramen of the occiput : and fome wa-
ter was alio found under the pia mater, when the cranium was open'd, par-
ticularly on the right fide. In the lateral ventricles of the cerebrum was a
reddifh ferum, and the plexus choroides were unequal, with a great number of
hydatids, which were eafily broken through by touching them. From the
factions of the medullary fubfiance, where fome bloody points were difco-
ver'd, a greater quantity of blood was prefs'd out than there generally is.
From this cerebrum, as alio from the tongue, the pharynx, and even from
the very eyes themlelves, which I difiected, the fame kind of odour of worms
was perceiv'd, that I fpoke of in the belly.
17. If you let afide what relates to the delirium, to the convulfions, to
the fpitting of blood, to the pains of the breaft, and the other diforders,
which are not the objects of our prelent inquiry, and only confider the pains
of the interlines •, you will eafily conceive, that when thefe as well as the other
fymptoms, had fo greatly remitted, without any critical evacution preceding,
that the woman was fuppos'd to be recover'd, nor fhe herfelf longer felt any
pain, the interlines had then begun to grow livid, and black, which the dif-
charge of a foetid blood by flool, beginning on that very day, to fay nothing
of the alphyxia, join'd to demonftrate.
Nothing in the whole practice of medicine, ought more to be fufpecled than
the Hidden vanifhing of pain contrary to our expectation. I remember that the
very fagacious, and experiene'd phyfician, Peter Molinelli, whom I have com-
mended in the life of Valfalva, related to me a recent obfervation of his, to
the fame effect. A young man of a melancholic temperament, was feiz'd
with an acute fever, with an inflammation of the jaws, and a delirium.
About the fourteenth day all the other fymptoms, befides the fever, left
the patient, but that continu'd, and was conftant j and although the patient
perfpir'd plentifully, and made a good deal of water, yet the fever, except that
it feem'd to have been abfent for one day, ran on quite to the thirty-fifth day.
As Molinelli fufpecled, from the obftinate perfeverance of the fever, even after
fo great a difcharge by fweat, and urine, that fome very confiderable difor-
der was lurking beneath it, behold without any previous irregularity of the
patient, or the attendants, an asruginous diarrhoea fuddenly came on, which
was attended with a pain a little above the region of the bladder. And as
thefe fymptoms came on fuddenly, fo they as fuddenly vanifiVd.
Then indeed the phyfician began to fear fomething very violent, and not
without reufon. For the whole abdomen was harden'd to an incredible de-
gree, \vith a fenfe of internal heat, and, .when you touch'd it, even of pain :
at the fame time there was no pulfe, a delirium came on, a difficult refpiration,
and, without figns of convulfion, death within the third day, from the time
the abdomen had .:rown hard. And although he was furpriz'd, how an in-
flammation could arife from blood, which was effete, as it mult necefiarily be,
after a very long, and violent illnefs ; yet that it was anfen he did not doubt ;
(z) IX. N. 14.
and
176 Book III. Of Difeafes of the Belly.
and I did not doubt but a gangrene had arifen alio. But what it was not pofil-
ble compleatly to afcertain, by reafon of the liberty of opemng the bo !v , this
young man being denied, it was poffible to aicerrain in a woman of the firft
rank, whofe hiftory being communicated to me by one of her phyficians,
mould not be pafs'd over here, as it was very much like thofe which are de-
fcrib'd above.
1 8. A very great princefs of fifty-four years of age, who was not fat in her
limbs, but very fat in her belly, in whole pulfe it was remarkable, that after
every two laudable ftrokes, immediately follow'd as many ftrokes that were
low, and of unequal celerity, having ieem'd to be recover'd from a very
violent pain of the interlines, which drew the bladder into confent, and pre-
vented the power of making water, was, a very few days after that pain had
left her, feiz'd with a diarrhoea, by which (tools of a black colour were dif-
charg'd, and foon after with death.
The belly being open'd, fome of the inteftines, and the ftomach, were
found to be affected with a gangrene •, the gall-bladder was dry, and in it
was a calculus of the bignefs of a fmall pear : in the kidnies were rather gra-
nules of fand than calculi. In the thorax the heart, and pericardium, were
over-loaded with fat.
19. Whether this oppreffive quantity of fat, or even fomething here-
ditary, as thofe things which I remember to have read, formerly, of the
king her father, leem to prove, was the caufe of that inequality of pulfe, I
fhould at leaft think that the gangrene of the inteftines was to be attributed
rather to the foregoing inflammation, when the pain troubled her, than to
the difcharge of atra bills, as it is commonly call'd, by ftool. For this dif-
charge had not infected the ftomach •, and in the widow of whom I fpoke juft
now (a), black ftools preceded her death, which did not confift of atra bilis,
but of putrid blood.
Yet it is not very probable, you will fay, that many experiene'd phyfi-
cians, and efpecially fuch as are generally call'd upon to attend princes, did
not diftinguifh an inflammation, nor the degeneration thereof into gangrene.
And as it is my cuftom to judge of others, and particularly in a dijorder
which I did not fee myfelf, as I would have others judge of me, I will here,
alfo, preferve my cuftom of accufing nobody rafhly ; and unlefs you diffent,
I will fay that this gangrene came on without any previous inflammation.
And this I fhall do under the countenance of a great authority, I mean of
Fernelius (£), who, after a very violent pain, faw " the extremity of the foot
" fuddenly fphacelated, without any confpicuous rednefs, fo that the patient
" was, at length, carried off without any fever, without any very violent
M fymptoms." Although therefore, " the greater part of phyficians think
" that fphacelus is the indivifible confequence of violent inflammation," yet
from confidering feveral obfervations, which are very fimilar to that of Fer-
nelius, Frederic Hoffmann has exprefsly laid (Y), " wherefore there is no rea-
M fon to doubt, but the fame thing may happen internally, in the vifcera,
" alio, without a previous inflammation."
(a) N. 16. ■ (c) Diflcrt. de morb. hep. ex anat. deduc.
(<£) De abdit. rerum cauf. 1. 2. c. 15. §. 19.
A But
Letter XXXV. Artiele 20. 177
But if you want inftances in the inteftines thcmfclvcs, you nay read over
again the observation or" Scgerua (J) : or rather, as in his obiervation there was
a very violent pain obfeiVd, and a very quick motion of the artery, turn to
another of Frederic Ortlobius (<•), which is alio to be met with in the Se-
pulchretum (J) : you will find that the inteftines were " livid, black, and
" Iphace-latcd," on the right fide, and that, as Ortlobius himfclf wonders at
in the leholium, " without previous pains ot the belly, and without a pre*
" vious manireft fever*"
20. Yet even as in the patient of Ortlobius, " obfeure pains" of the belly had
preceded * and as there is nobody who can affcrt of him, as Ferrjuelius did
ot the foot of the other, whom I fpoke of jult now •, or who can alcertain,
as in the external parts in general, that a " confpicuous rednefs" had not
preceded, in the vifcera alio, you will not deny that a fphacclus of the in-
teftines may, fometimes, happen, without any inflammation preceding ; but
will at the lame time enquire whether it may not, fometimes, fucceed to an
inflammation, the principal, and common, fymptoms of which do not ap-
pear.
Not to recede from the Sepulchretum, turn, I befeech you, to the ob-
fervation of Riverius (g), in this very fourteenth lection. The inteftinum
ileum, you will find, was affected about its termination, together with the
portion of the mefentery that was join'd to it, with a gangrene, and even
with a fphacelus, in a patient who having labour'd under a pain of the
interlines, on the firft day of his diforder, which was protracted to the thir
teenth day, but " being free from pain, and from fever," on the lecond
clay, caus'd great doubts and difficulties to ante among the phyficians, on
the third and the following days, as " the fever which came on alter the fe-
" cond day, together with a thirit, and drynefs of tongue, feem'd to give
" proofs of inflammation •, but they could not conceive how an inflamma-
" tion could exift in the inteftines, without pain."
Shall we fuppofe then that the fphacelus happen'd on the firft clay ? It fo, we
mull, alio, fuppofe that the patient liv'd in this ftate, for the fpace of twelve
days. And can this be fuppos'd ? Or how could it happen, that after the
fphacelus was form'd, a fever, which did not exift before, and a drynefs of
tongue, came on ? For you will fee in the preceding letter, that the pulfe of
an old man (£), was, from a febrile ftate, chang'd at length to the appearance
of a healthy ftate, and that the tongue, from a dry ftate, was become moid,
although in his body after death we found a part of the inteftines ftill red, and
another part livid, black, and occupied with a gangrene, which were pretty
lure marks that this part had very lately pafs'd from inflammation, to gan-
grene. But as to pain, other letters of mine teftify, that inflammation of the
inteftines had exifted without it.
For to take no notice that in the twenty-ninth (i), the inteftines are not
faid to have been troubled with any pain, notwithstanding they were univer-
fally inflam'd to a great degree ; as I fuppos'd this to happen on account of
(d) Vid. fupra n. 15. (g) Obf. 21. §. 4.
(e) Eph. n.c. dec. i.obf. 143. (b) N. 25.
(f) L. 3. f. i.dbf. 11. (0 N. 10. 11.
Vol, II. A a tbeir
178 Book III. Of Difeafes of the Belly.
their being paralytic: they certainly were not paralytic in other patients, as^
for inftance, in the two who are fpoken of in the twenty-firft letter (A), and
ytt, although the inteftines were found to be inflarn'd, no complaint had
been heard of pain being therein. And to mention a patient whom you
may more eafily call to mind, a woman was defcrib'd in the preceding let-
ter (/), whole fmall inteftines were red in the chief part of them ; yet they
had lcem'd to be pretty free from pain. And indeed the other principal
fymptom of inflammation, which is fever, had never been obferv*d in this
woman, through the whole courfe of the difeafe : and in the porter, whofe
hiilory was given a little after hers (?«), the fever, whether you attended to
the pulfe being not very frequent, or the flefli not hot, was flight -, yet the
inflammation was not flight ; fo that there was no room in him, and much,
lefs in the woman, for the opinion of Ballonius («J, though in other refpedts
to be commended. Who after having faid " it was natural to fuppofe, that
" a considerable fever muft be the confequence of internal inflammations ;"
yet immediately adhering to the opinion of Galen, " who taught that in-
" flammations of the internal parts muft be very great, in order to bring
" on an acute fever," he fays this, if there be a " flight inflammation an
" ardent fever does not come on.**
21. And all thefe things being; confider'd, when together with the other
fymptoms of inflarn'd inteftines, you find a violent pain, and an acute fever,
attending the patients, you will deiervedly, and with juftice, give credit to thofe
medical writers, who have plac'd thefe two appearances among the principal
fymptoms of great inflammation, in the inteftines. Yet if you, at any time,
find that one, or both, of thefe are not prefent, or but in a flight degree,, you
will not immediately fuppofe, either that there is no inflammation, or that it is.
but flight, and that a gangrene, and Sphacelus, cannot exift in the inteftines
of thofe perfons, in whom you do not fee that thefe two fymptoms have
preceded. It were much to be wiuYd, I confefs, that phyficians when they
have recounted the fymptoms of this inflammation, and of a gangrene that,
is the confequent of it, would not omit this monitum in a difeafe, which by
a deceitful appearance of this kind, frequently brings on a fwift and fud-
den deftru&ion. fay frequently. For I remember, when with furprize
I related to Valfalva, and Albertini, the cafe of the young man which I de-
d«fcrib'd to you above (0), that both of them, immediately, affirm'd nearly
die fame thing to have happen'd to them, more than once.
At which time Albertini inculcating upon me, that it was neceflary to
watch, and be cautious, in pains of the inteftines: for that he after flight
pains, or at leaft with thofe which were by no means considerable, without
any manifeft fever, without any convulfion, without any vomiting, when
both the internal, and external, fenfes were vigorous, and ftrong, had feen
patients fall very fuddenly into the utmoft danger, and be foon fnatch'd away
by a latent inflammation of thefe vifcera, degenerating into an unexpected
fphacelus ; I fay Albertini inculcating thefe things upon me, I afk'd of
that very attentive phyfician, and diligent obferver, from what figns then
(i) N, c,. & 17. (*) L. 1. Confil. mcd. 112.
(/) N. 11. {0) N. 14.
{m) N. 18.
we
Letter XXXV. Article 22. 179
we might judge of the danger which threatens, and be able to foretell it at
lead. He anfwer'd, from the pulfe, the abdomen, and the face. For the pulfc
is low and rather weak, and it' you attend to it clofely has fome little irre-
gularity, which makes it not quite fimilar to jtfelf: and the abdomen i-.
tenie, hard, and attended with tome pain : and, finally, the face has i'ome-
thing unufual in its appearance, though different in different perlbns, fo that
fometimes I have obferv'd the eyes to look as if the patient were frighten'd,
at other times there has been a kind of lividnefs about the lips ; and theie,
laid he, are the moll: general appearances that it has happen'd to me to meei:
with, in cafes of this kind ; yet I have fometimes alfo obferv'd a morbid ap-
pearance of the tongue, and a kind of third.
Thus it was that he pointed out the fymptoms, with that ingenoufnefs
which was natural to his character. And the truth of his remarks has been
prov'd to me by the cafes of many, but particularly by that of Thomas Ale-
otti, a fellow-citizen of mine, who was equally eminent on the account of
his noble family, and the probity of his manners. For he being confin'd to
his bed, after certain pains of the belly, to which he was fubjecl, and not
recovering with the fame degree of quicknefs, that he had been accuftom'd
to recover with, his phyfician was fent to me about evening, in the autumn
of the year 171 1, if I remember rightly, when I was prevented from going
abroad by a flight diforder, to confult me upon the cafe: this phyfician hav-
ing told me that the patient was attended with fome of thofe fymptoms,
which I mention'd juft now, and having found out, by the qucftions I afk'd
him, that others were not wanting, I dcfir'd him, quite contrary to his ex-
pectation, to return to the patient, and if he obierv'd him to be grown ne-
ver fo little worfe, to take care to inform the people about him, that a very
confiderable danger might be at hand, and that the patient might fettle all
his affairs refpecting both himfelf, and his family.
You will naturally inquire what was the event? Why a very few hours af-
ter, the patient having begun to grow manifeltly worfe, and having imme-
diately done thofe things, of which he was at length admonihVd, this ex-
cellent man was fnatch'd away by a fpeedy death, within the courfe of that
very night.
22. But as the nature of medicine is fuch, that the fame things do not al-
"ways anfwer in the fame degree, I would have you make ufe of what I have fa id
in fuch a manner, as, if at any time you fee the greater part of thefe fymp-
toms, which I have mention'd, come together, to be at leaft fufpicious of the
confequences, and obferve the fucceeding fymptoms with great caution and
attention. And in the mean while, perhaps, it will not be altogether without
advantage, if you compare with the obfervations, which are written in this
and the former letter, on the one hand, the greater part of the fymptoms
recounted by Albertini, and on the other hand, thofe which are generally
given by phyficians, in order to diftinguifh the inflammation of the inteftines.
Albertini had obferv'd the pulfe to be low, and rather weak, fuch as you will
find it to have been, in general, in the foregoing letter, under number nine,
eleven, eighteen, and twenty-five, and in this, under number two, to fay
nothing of the afphuxia, which was at laft obierv'd in the fame cafe, and
under number fourteen, and fixteen. He had alfo obierv'd the abdomen to be
xenfe and hard •, the face and eyes to have fomething unufual in their appear-
A a 2 a nee-:
i8o Book TIL Of Difeafes of the Belly.
ar.ce : of which circumftances, you will find what has been obferv'd under
all the numbers mention'd above, except the eleventh, and fixteenth, where
nothing is faid upon the fubjeel:.
Medical writers, indeed, agree in the tenfion of the abdomen. But they
add many other fymptoms which prove, beyond a doubt, the inteftines to
be inflam'd ; yet they mean that evident inflammation, which all may eafily
ascertain, and not this obicure dilbrder which we now fpeak of, and which
very few fufpect. Among thefe fymptoms are, particularly, an acute fever,
and a violent pain : without which, however, I have mown, above (p)y
that this inflammation has exifted. Befides, in regard to the fever itlelf
only, I would have you read the obfervation written by the celebrated
Rofa (q), and you will find, " that the whole inteftinal fyftem was in-
" flam'd, and gangrenous," and yet, " that in the whole courfe of the dif-
" cafe, not the lead increafe of celerity in the pulfe could be obferv'd, nor
** any febrile motion."
This author, alfo, defcrib'd a peculiar cafe, in the year 1745. But before
this i not before the oblervations of my preceptors, and mine •, the cele-
brated Simpfon had publifh'd thofe things, which gave the illuftrious archia-
ter, Van Swieten (r), a proper occafion of commending him, and confirm-
ing the opinion in thofe words, which, although you wijl fee them repeated
by more than one of our Italian writers, in tne years laft pail, it will, ne-
verthelefs, not be foreign to the purpofe to quote on the prefent occafion :
" Simpfon has given us a caution, which muft prove very falutary, and
*c ufeful, in the pra&ice of medicine, and tend to prevent thofe practitioners
" from being deceiv'd, who fuppofe that there can be no inflammation, where
" there is no fever. Whereas an inflammation often produces fix'd pains of
" the inteftines, and ftomach, although no fever can be obferv'd by the ex-
" amination of the pulfe." You fee this very experiene'd man lays, that
the cafe happens " often ;"' fo that he does not doubt but this is " a caution,
u which muft prove very falutary, and ufeful, in the practice of medicine."
And this was what I myfelf, in the year 1703 fj), wonder'd fhould have been
omitted, by thofe phyficians that I have at prefent in my eye, who had taught
us the fymptoms of inflammation of the inteftines, as they had of all other
diforders. Thus far then as to fever.
But in refpecl to pain, it muft be added, at prefent, that it is fuppos'd,
by the fame pnyficians, to be join'd with a fenfe of puliation, and of conftdcrable
heat, fuch as you will find in none of our obfervations-, and you wirl even
read one(7), in which, when I exprefsly enquir'd after a fenfe of pulfation, and
heat, the exiftence of both one, and the other, was particularly denied. In
many, (u) you will rather find the pain to be fo defcrib'd by the patients,
as if dogs were gnawing them.
By the fame writers it is alfo fuppos'd, that there is obftinate coftiveneis,
and continual vomiting, efpecially if the fmall inteftines are inflam'd, fo that
the excrements are, at length, difcharg'd by the mouth. But you will cer-
tainly find nothing of this kind, by reading, over again, what is faid above (a1),
(/>) No. 20. (/) Epift. 34. n. 9.
(<>) A&. n. c. torn. 8. ohC 47. {u) Ibid. & n. 18 & 25. & in hac epiflola,
(r) Comment, in Boer. aph. §.. 371.. n. 16.
\s) N-14. &.ai. (.v) N. 10. 12. 16.
oi
Letter XXXV. Article 23. i8r
of the fcrvant. the old woman, and the other woman at lead: : n.iy, the lat-
ter had even a laxity of the inteftines. Third: alio you will in vain fcarch for
in many : I do not mean that (light third which Albertini has fomeiimcs ob-
ferv'd, but that which they call very troublcfome, and which they fay is the
natural attendant of an acute fever. I omit other things, for it is not my in-
tention to refute writers, whom I greatly cfteem •, but only to (how that thofe
fymptoms which are deliver'd as the principal arguments of inflam'd intef-
tines, are not always to be depended upon, as they are not always prcfent,
where this inflammation exiils.
23. However, I cannot fufrkiently, and according to their merits, com-
mend thofe gentlemen, for admonifhin>r tis that the inflammation of thefe
vifcera, ealily, and frequently, degenerates into gangrene, and iphacelus, and
that this may be argu'd from the hidden departure of the pain. Without
doubt it is from the fame caufe, that if this happen in a dyfentery, the pa-
tients are loon carried off, when they themfelves, and thofe about them, aic
lcfs apprehenfive of it. You have in this third book of the Sepulchrctum,
and in the eleventh lection, an ingenuous confeffion of Drelincurt (y), which
is worthy of Hippocrates himfdf: for Drelincurt " being rejoie'd" on account
of the pains of a dyfenteric patient having vanihVd away at once, had reafon
to repent of his joy three days after, when the patient died without pain, by
reafon of the vifcera being " blafted," or, in other words, fphacelated to a
furprizing degree. And when I wrote to you, on another occafion (z), I
conjeclur'd it to have happen'd from a fphacelus of the intellines, that in the
lait days of a dyfentery, and of life, the fever has even fometimes feem'd tO>
be gone off-, and in this (a), and the former letter (£), I have fhown what
not only the ceiTation, but the remitlion alfo, of thefe, or other fymptoms,
when they happen contrary to our expectation, may be fupposM to be argu-
ments of.
Yet take care how you believe, on the other hand, that in thofe patients,,
in whom there is a fphacelus of the inteftines, the pains always ceafe, as you
are taught the contrary by the hiftory of the young man (c), who, though he
was oblig'd to cry ou-t incefiantly, with excruciating pain, for the laft fifteen
hours of his life, ncverthelefs had the greateft part of his inteftines black, to
as great a degree as can be conceiv'd. For the part which yet remains found,
a dreadful inflammation, or fome other caufe, may, in the mean while, excru-
ciate •, as, for inftance,. a convulfion, or what we obferv'd in that young man,
and frequently in others, who labour'd under the fame diforder (d), I mean,
inteftinal worms.
But whether it happen'd accidentally, or becaufe deprav'd, and irritating
remains of the chyle are the coniequents of a depravity in the bile, that
others (e)> as well as myfelf ("/), have found calculi, in the gall-bladders of
fome of thefe patients, I leave quite undetermin'd-
However, diicharges of black matter by Itool, when join'd with a ceiTation
of the pain, as I have taken notice of above i'^), are with great juftice, ana.
(}■) In addit. obf. 4.. (<?') Supra n. 16. & epift. 34. n. 9. & 33.
(?) Epift. 31. n. zQ. (e) Via. obf. 47. cit. fupra ad n. 22.
(r.) N. 14. 16. io. (f) Epift. -.1. n. 15. &Yupra.n. 16. i3
(0 N. 15. Q) Num. lifd.
(0 Supra n. 14.
182 Book III. Of Difeafes of the Belly.
propriety, plac'd in the number of the moll alarming fymptoms, and thofc
which fhow death to be near at hand : and to this we (hould alfo add, that
which I have defcrib'd to you in another letter (&), not, indeed, as bein^
join'd with a pain in the interlines, which, by reafon of their paralyfis, hac
never taken place, but as being join'd with a great inflammation of frhem all.
The next letter you are to expect will be on the fubjed of tumour and pain of
the hypochondria. In the mean while farewell.
LETTER the THIRTY-SIXTH
Treats of Tumour and Pain of the Hypochondria.
FOR thofe reafons which I have given in the thirty-fecond letter (a), I
pafs over the vt -ry (hort itchon, upon the piles, which follows in the
Sepulchretum, and come immediately to the two next fections to this, that
o the fixteenth, and feventcenth, and intend to comprehend the argu-
n '.nts of thefe two fections, which are tumour, and pain, of the hypochon-
dria, in this one letter. For thefe two affections are frequently join'd toge-
ther, as it will be eafy for you to perceive, from thofe very obfervations of
Vallalva, with which I begin.
2. A woman of forty years of age, of a yellowifli complexion, had long
been troubled with a hardnefs in the right fide of her belly, which went down
quite to the os ilium, and below it. If you touch'd the tumid part it was
painful. She was thirfty. For about a month before her death, fhe com-
plain'd of a pain in her ftomach, after taking food, and breath'd with diffi-
culty. On fome of her latter days a vomiting had come on ; but on the two
lad, a very fevere and violent pain.
The abdomen was found full of a yellow water, which was bitter in its
tafte, and, like the ferum of the blood, coagulated when on the fire. The
ftomach was narrow in the middle, fo as to refemble the ftreightnefs of the
pylorus, and, in fome meafure, to bear the appearance of two ftomachs.
The liver had grown out into a great bulk. For with its right lobe it reach'd
almoft to the lower part of the. belly. The fubftance of this lobe was uni-
verfally indurated, and, in many places, diftinguifh'd with whitifh bodies,
fome of which, that were the largeft, were equal to a filbert in magnitude :
when it was cut into, it fhow'd, in fome places, a beginning of erolion, and
a putrefaction of the juices to have been at hand. And the left lobe of the
liver, being in like manner indurated, prels'd upon the ftomach in that part,
(h) 29. n. 10. (") K. 10.
where
Letter XXXVI. Article 3. 183
where I have faid it was fo much ftreighten'd. The coats of the gall-bladder
were become thick, and the cavity very much ftreighten'd -, and in the cavity,
was contain'd a black, thick, and vilcid bile. In the abdomen of this body
was no appearance of iymplutdufts.
In the thorax the lungs were whirifh, and variegated with fpots of a b'.ackifh
hue : the left lobe was connected, in iome degree, to the back ; but the right
was every where free. The ventricles of the heart contain'd a fluid blood ;
yet in the right was the flight beginning of a polypous concretion.
3. In three ohfervations which I have produe'd in other letters (b), I have
defcrib'd the ftomach to be double, as it were, yet not divided by lb great
a conftriction, as in the prefent cafe •, though I have taken notice of a con-
ftriction, which was ftill greater than this, from Blafius (r), in a man who had
been, in every refpecT:, healthy, except his extreme hunger. Nor did I
doubt but ftruclures of the ftomach, of this kind, had exifted from the ori-
ginal formation of the body (d) : for which reafon, I did not fcarch after
the caufe of thefe conftrictions in the liver, although, in the two firfh of thofe
oblervations, it was extended towards the left fide, more than it naturally is,
but not hard, efpecially as in the third, the liver was within its natural
bounds: nor indeed in the laft-mention'd obfervation, did I account for the
vomitings, and pains of the ftomach, from that conftriction in particular, as.
they had not been obferv'd in the two former.
Yet here I fhall afcribe the fame fymptoms to the greatnefs of that con-
ftriction, inafmuch as it feems to have been more and more increas'd, con-
trary to what generally happens in the latter part of the difeafe, from the hard-
nefs of the liver increafing every day, and comprefling that part of the
ftomach in particular. For not only reafon, but manifold obfervation, con-
firms how much the functions of the ftomach are difturb'd, when this vilcus
is comprefs'd, and deprefs'd, by the increas'd bulk of the liver : as you Will
fee from the obfervation of Bartholin (e), on a girl of fix years of age ; and
of Fantonus the father (f), on a prieft, the latter of which had the bulk of
the liver fo much increas'd as to fill " the whole epigaftrium," and the for-
mer, fo as to occupy almoft " the whole abdomen." It is true the liver, when
not at all morbid, rtretches its thinner part, fometimes, quite to the 1'pleen,
as I have taken notice in a former work (g) : but when it is difeas'd, it has,
fometimes, fcarcely any bounds to itsextenfion through the belly. Neither of
which circumftances ought to be unknown to phyficians, and furgeons, left,
they fhould be deceiv'd, in fome cafes, by that appearance which is com-
mon.
Where the liver is found there is room only for fufpicion -, as for inftance,.
if a wound, by chance receiv'd upon the left hyochondrium, be attended
with fymptoms different from thofe, which generally attend the wounds of
the vifcera, that every body knows to be plac'd there. But when figns of a
difeas'd liver are not wanting, as in the woman we are fpeaking of, the yel-
lowifli complexion, and hardnefs, beginning from the right hypochondrium.,
(£) Epift. 16. n. 38. epift. 26. n. 31. epift. (<-) Sepulchr. 1. hoc. fe£t. 1. obf. 4.
30. n. 7. (f) Obf. anat. mcd. 24.
(c) Ibid. n. 8. (^) Adverf. 2. animad, 2,
(d) Epift. 26. n. 32.
5
1 84 Book III. Of Difcafes of the Belly.
it will be lefs difficult, in fuch a cafe, to afcertain the extenfion of the liver
to that part, to which the fame continued hardnefs extends itfelf.
But whether in the other woman, whofe hiilory follows, the continuation
of the pain, if you prefs'd the part with your hand, went lb far as to prove
the fame thing, may better be conjectured by us, than affirm'd ; as Vallalva,
who was then a young man, and wrote his obfervations on the living body
with great brevity, has not determined the qucftion.
4. A woman of fixty years of age complain'd for a long time of a pain
above the umbilical region : fhe had a third •, fhe cough'd ; and fpat up a
catarrhous matter. Lalt of all, (lie breath'd with difficulty: a few days be-
fore her death her belly fwell'd fuddenly to a great degree ; her feet were af-
fected with an ccdematous tumour. At length, that pain going off by degrees,
fhe came to the final period of her life.
In the belly was a great quantity of limpid water : but no traces of the
lymphatic veffels. The fpleen was twice as big as in its natural fize. The liver
was hard : and the gall-bladder was full of fmooth calculi. But in another
part of the liver, a congeries of veficles was leen adhering to it, from which,
when lacerated, a ferum was difcharg'd. And within the fubftance of the
fame vifcus, towards that part which was turn'd to the diaphragm, was found
the cavity of an abfcefs, which occupied more than a third part of the liver.
The matter of the abfcefs had burit forth into the cavity of the thorax, on
the right fide, which was univerlally full of a famous pus. Yet the lungs
were iound.
5. As you have been inform'd into what part the abfcefs of the liver had
built, I do not doubt but you now wifh, with me, that all the fymptoms which
attended a cafe of this kind, that, perhaps, had never before occur'd to any
one, and particularly the latter fymptoms, had been collected by Valialva
with more exactnefs. For Stalpart (£), when he wrote of a certain man, in
whom pus had pafs'd from an abfcefs of the liver, not plentifully, nor into
the cavity of the thorax, but in a fmall quantity, and into the lungs, through
a fiftula that perforated the diaphragm, which was become confolidated with
both of thefe vifcera, added no example of the fame appearances having been
feen in diffection, by any other perfon, contrary to his ufual method, and
contrary to what might have been expected from his extenfive reading.
And after him, if we look for obfervators that are to be depended upon,
as we certainly ought, I do not, at prefent, remember to have read any au-
thor, who has met with the fame appearance, and (till lefs with the fame as
Valfalva has defcrib'd. Who, I fuppoie, has left in writing all the fymptoms
he was able to collect. But amongft them you fee to what caufe the tumour
of the belly, and the cedematous fwelling of the feet, are to be afcrib'd.
And there may be a difficult refpiration, from the liver being thus affected,
even when the diaphragm is found; as there may be a cough alfo, the origin
of which was fo much the more ambiguous in this woman, as it had an ex-
pectoration of catarrhous matter join'd with it.
There are extant here in the Sepulchretum (/), hiitories Of abfeeffes in the
liver, to the number of twenty. But there is not one of them all, in which
Cb) Obf. rr.r. ±6 cent. 1. (») Sett. 17. cbf. 2.
a Greater
Letter XXXVI. Article 6. 185
a greater care in the obfervation of the fymptoms is not to be defir'd, if you
pt that of the man of Nuremberg (k), which is defcrilAl by Coiterus.
But in him a vomica had poflefs'd the flat furface of the liver, io that it ap-
pears to have open'd itfelf into the cavity of the belly. And on the fame
Bat part, it was in a young man whom Paawius (/) diffected -, but this had
not difcharg'd its pus •, fo that the foramen, " which was big enough to ad-
" mit two clench'd fifts," form'd by an " erofion" of the diaphragm, Ci in
" that part which lies on the left fide of the liver," is not fuppos'd to have
been form'd by the eruption of the pus : befides, none of the fymptoms,
which preceded the patient's death, are related, as none are, in like manner,
in another cafe (w), wherein the fame Paawius found two ulcers in the gib-
bous part of the liver, which penetrated inwardly.
Nor will you read the peculiar fymptoms of the liver being fuppurated,
in the obfervation of Blafius (n), where the abfeefs was of fuch a nature,
that the coat of the liver was the only part which feparated the pus from
the diaphragm, to which the liver was clofely connected. And thefe things I
took notice of that you might perceive the more clearly, how very defirable
it was that what others had not done, could have been done by Valfalva ;
I mean in regard to the fymptoms, which are, for the moft part, common to
abfeefles of the liver, and which are not yet afcertain'd, or, at leaft, fuch as
are not in the number of thole that Coiterus has remark'd, befides a cough,
and a thirft, which Valfalva has alfo remark'd : and whether thofe are among
the figns of a ruptur'd abfeefs of the liver, which are pointed out by Coite-
rus, in the following manner : " the tumour, and hardnefs," which had been
in the right hypochondrium, and the region that lies beneath it, " vanifh'd ;
<c and the patient being feiz'd, on the fame day, with fome fwoonings, ex-
" pir'd." For Valfalva mentions nothing to this purpofe, but that the pain,
which had been above the umbilical region, " went off gradually," perhaps
from the matter of the abfeefs being carried off, more and more, from thence
into the thorax. And what detriment happen'd to the action of the thorax,
from this metaflafis, he does not fo much as hint at •, as he, likewile, does
not fay a word of refpiration being made more difficult, nor yet a word of
fwoonings.
6. If you read over the great number of hiftories, which were pointed outjuft
now, in the Sepulchretum, you will find that the laft-mention'd fymptoms have
no more been obferv'd, in thole where a vomica of the liver had difcharg'd
itfelf into the cavity of the belly (0), than fudden death itfelf, if you except
a man whofe cafe I have mention'd, as being defcrib'd by Coiterus (p) : and,
on the other hand, you will read that a baker (q), whofe liver had fuppurat-
ed, " was fometimes feiz'd with a fwooning," though, at the fame time, the
" membrane of that vifcus was untouch'd and found. Neverthelefs, both of
thefe circumftances, which are not to be met with in thofe hiftories, has fo
often occur'd to phyficians, and among others, to my preceptor Albertini,
that he prefs'd it very earneftly upon practitioners, not to fuffer a patient to
(*) §• 6. (e) §. z. & c.
(/) Ibid. §. 7. g. (j,) §. 6.
W *• 8; (?) §• '+•
(/;) 5. 16.
Vol. II. B b be
1 86 Book III. Of Difcafcs of the Belly.
be mov'd when there were fymptoms of an abfcefs already form'd in the
liver-, not becaufe he was ignorant that motion has been prefcribM, at this
time, by authors, who are, in other refpects excellent, which I alio read ) :is
Succeeded happily fometimes in our memory ; but becaulc he fuppos'd, that
without tiling motion, it would, probably, happen, that the pus of an abfcefs
lb ruptur'd, without injuring the membrane of the liver, might be carried
down to the inteftines, through the branches of the biliary duel ; and be-
caufe from a contrary practice, he forefaw how eafily the external membrane
of the liver might be ruptur'd, fo that the pus fhould be pour'd out into the
cavity of the abdomen, and kill the patient inftantly, by bringing on a
lyncope.
For this he remember'd to have happen'd at Bologna, at the time he was
a young man, when an excellent phyfician, and, at the fame time, an emi-
nent furgeon, following the practice of thofe authors, had prefcrib'd motion
to a virgin who had a fuppuration in the liver ; by which means the pus
being pour'd out into the abdominal cavity, the patient died foon after, in
the arms of the women by whom fhe was fupported. And he had after-
wards obferv'd the fame thing to happen, even without motion, at leail with
a flight motion, fuch as we naturally ufe in bed, or while we are rifing from
bed, in feveral perfons, but particularly in a noble marquis, who had an
abfcefs in the concave part of the liver. And by thefe obfervations I was
influene'd to fufpect, that almoft the fame kind of death, in another noble-
man (all the fymptoms of whofe dilbrder I will write to you accurately at
another time (r) ) was to be accounted for from almoft a fimilar caufe. But
he fo much the lefs approv'd of motion, becaufe the abfcefs is fometimes fo
large, or of fuch a kind, that although it may find an exit, by chance,
through the biliary ducts, yet the patients cannot be cur*d with that fuccefs,
which had happen'd to him, in a matron of the firft rank, and in like man-
ner in a fervant-maid, both of which he aflur'd me he had perfectly cur'd,
by a long perfeverance indeed, but not by any other medicines than tur-
pentine refin, and whey, and afterwards by the juices of ground-ivy, and
the cohfolida media.
For where a vomica of the. liver has open'd a pafiage for itfeif, through
the mulcles of the abdomen, two inftances of which happen'd at Bologna,
although even then, all endeavours were us'd not only by internal, but by
external remedies applied to the cavity of the abfcefs, that the liver might
be heal'd, yet they were able to bring about this effect, only in one of the
cafes: but in the other, in which a matter fometimes was difcharg'd, that re-
fembled water wherein frelh meat had been wafh'd, and fometimes a yellow
humour, they could not obtain the fame fuccefs ; and the patient died at
laft : notwithftanding in him the tumour had not been open'd fo much by the
force of nature, as by the error of art. For the phyfician, although a man
of good reputation, and the furgeon with whom he was affociated, by no
means attending to this, that the jaundice had preceded, and other ap-
pearances, in like manner, which fhow'd the liver to be affected, had fuffer'd
themfclves to be deceiv'd by the touch, perhaps for the kw caufe, which
(.••> Epift. 4.0. n. 28. .
was
Letter XXXVI. Article 7. 187
vnt found by Fantonus the father (j), in the extenuation of the abdo 1
mufcles, fo as to imagine the tumour, which v :.t!ly in the liver, I
in thefe mufcles 5 for which realbn, by applying emollient cataplafms, they
had, with a miftaken diligence, brought en a fuppuration.
You fee what it is I dilapprove. For I am not one of thole who hold that
where nature, itfelf, urges the fuppuratcd tumour of the liver, to the mufcles
of the abdomen, the pus fliould be fuffer'd to remain there, for a longer
time than is neceflary, and by this means be increas'd ever) day, become
more acrid by ftagnation, infect the blood, erode ilill other and other [
of the liver, and open a palfage for itfelf, which would be lefs expedi
as for inltance, into the tlomach ; for into this cavity was fuch an al
found to have burll, by Vogelius (/), through a large foramen •, and into the
thorax, as I have fliown above; or, which happens more frequently than either
of the foregoing, into the cavity of the belly, from whence a How and (in-
ferable death is brought on, if the immediate danger is avoided, which I have
laid was i'^n by Albertini («), and is conlirm'd by the illuftrious Van Swieten
(x). His words are, " there is danger left a fwooning, and fudden death,
" follow, at the time when an abfeefs of the liver is ruptur'd : for the
" branches of the vena portarum, that were before prefs'd upon, by the
" vomica, being now free from that preffure, by the difcharge of the pus,
" may eafily be ruptur'd from the blood milling into them with impetuofity ;
" efpecially as they have been macerated, and almoft half-eroded, by a
" very acrid pus having fo long lain upon them." Wherefore, agreeably
to the opinion of this, and other authors of weight, I would, before thefe
fatal accidents could happen, inform the patient, and the intimate friends,
or relations, of the patient, how many and how confiderable dangers
threaten'd, if a free opening were not given to the pus, as foon as pof-
fible : and yet that if this free opening were given, with all that caution
which the cafe requires, a recovery was not always, but fometimes only, to
be expected, and that this was fignifled by the aphorifms of Hippocrates (y) ;
and even that thofe abfcelTes of the liver alio had been more than once heal'd,
from which when open'd, far different humours were difcharg'd, from what
Hippocrates had willi'd : to which kind of inftances you will alfo add that, al-
though the cure was long, and difficult, which is defcrib'd by the celebrated
Jo. Peter Albrechtus (%)
But now to come back from this digreffion, let us go on, from the confi-
deration of thofe fymptoms, which Valfalva has not taken notice of in the
hiftory of this woman, to the confideration of thofe that he has remarkM.
7. Do not fuppofe that the congeries of veficles, adhering to the liver, and
when lacerated difcharging ferum, was any thing elie but hydatids, as he
himfelf has exprefsly laid, in a feparate paper, that they were fuch as are
frequently found to adhere to the morbid liver, externally. And you may
with propriety fuppofe, that the quantity of limpid water, which was found
extravafated in the belly, was the effect of many, and without doubt, of the
larger veficles* being burft afunder, by the quantity of ferum, with which
(/) Obf. anat. med. 13. (*) Comment, in Boerh. aphor. §. 9^9.
(/) Ad n. c. torn. 5. obf. 90. (y) 44. & 45. f. 7.
(;/) N. 4. (2) Eph. n. c. dec. 3.3. 5. obf. 22.
E b 2 they
1 88 Book III. Of Difeafes of the Belly.
they were turgid, or, at lead, in fome meafnre. T, therefore, would not
have you fuppofe, that thefe were of the fame nature, of which thofe pecu-
liar veficles were, fill'd with a yellow humour, that you will read the de-
fcription of, from the obfervation of Valfalva, in the third of the EpiftoU
Anatcmica (a).
But I fhall not repeat thofe hiftories here, notwithftanding they all relate
to diforders of the liver, and fome to abfcelfes of it, as I am determin'd to
purfue my original method, which is to avoid that negligence, in confe-
quence whereof, you will find that a great number of repetitions have been
admitted into thefe fixteenth and feventeenth fections of the Sepulchretum.
For to omit taking notice that in the former feclion the twelfth and eighteenth
oblervations are the fame, in the latter thofe are certainly the fame, which
are pointed out in the fecond obfervation, under article the tenth, and the
twentieth, and in like manner, the fourth obfervation, and article the fourth
of the eleventh, and that which is in the following eighth article, and that
under number two, article fifteen, and under the fame number eleven, the
articles two, and fix ; to fay nothing of the fame, which are repeated totidem
verbis in the fcholia to the fixteenth, and eighteenth obfervations. But with-
out repeating what I then wrote, I fhall add only three things to thofe hif-
tories of Valfalva.
8. And firft, to that which is given there under number eight, it is pro-
per I fhould adhere to what it was not neceffary to add in that place : I mean
that theferum, with which the belly overflow'd, emitted a particular kind of
halitus, which fmell'd like what often proceeds from perfons in fevers, and
indeed frequently from their urine : but that when put on the fire, in a fhort
time it became lb turbid, inftead of continuing limpid, as to refemble cow's
whey not well depurated: and, at length, that by the force of the fire it was
wholly diflipated. Nor fhould this circumftance be omitted, that about the
lumbar glands, fome flight traces of the lymphatic veflels, which were much-
emptied, had difcover'd themfelves.
9. But to the next hiftory which I have fubjoin'd to that (b), nothing re-
mains to be added to make it compleat, according to the obfervation of Val-
falva, after having fufficiently defcrib'd it to you in a former letter (c). You
will perhaps rather expect from me, that as the veficles defcrib'd in that
hiftory, were contain'd within a very large one, as within a purfe, I fhould
defend the opinion of Valfalva againft many authors, the number of whom
I fee is much increas'd, within thefe few years, in particular, and who give
it as their opinion, that the veficles found in encyfted tumours, which fome-
times occur in the liver, and the other vifcera, do by no means relate to the
glandular follicles being enlarg'd. But I have no difpofition, nor indeed is
there any neceflity, to fall into that difpute again, fince the opinion of Val-
falva did not depend upon that hiftory only, nor upon any obfervation of
veficles whatever.
You may even fee that Vallifneri, who, in like manner, long before them,
favv bladders, or cyfts, pregnant with other fmaller bags, or veficles, did
(«) N. 8. 9. 10. (<■) XXI. n. 55.
(*) N. 9.
not,
Letter XXXVI. Article 10, ir. 189
not, in that very writing which I then refer'd to, take any veficles whatever,
for glandular follicles dilated. Nor did Valfalva find veficles only in encyik-d
tumours of the liver, for in that hiilory, certainly, which I have joft now
compleated to you, he had found the whole liver made up of veficles : al-
though even in thofe cyltic tumours of the fame vifcus, it is not put beyond
all doubt, that the included veficles can by no means relate to glandular
follicles. And what if veGcles not unlike thefe, have fometimes appear'd in
external encyfkd tumours ? Do they, as they are external parts, for that rea-
lbn want glandular follicles ? But, as I have already laid, I would not wifli
again to enter into thefe deputations.
10. It is much better to attend to this circumflance, likewife, in the laft
of thole hidories of Valfalva (d), which Malpighi cxprefsly commended in
it; I mean the biliary due! communicating with the abfeefs of the liver, by
a large orifice, and dilated in the remaining part univerfally, fo that it ma-
nifeitly appear'd how this duel: might take up the veficles . from the cavity of
the abfeefs, and tranfmit them quite to the duodenum. For which reafon we
have the lefs occafion to doubt, whether this duel: does not frequently tranfmit,
through its corroded branches, blood, and pus, which it has receiv'd from
vomicae of the liver, down to the inteflines, in the manner that is taken
notice of above (e) •, and as the biliary ducts being much enlarg'd, having
the orifice, by which the bile flows into the duodenum, big enough to ad-
mit a little finger, with great eafe, evidently confirm'd, in a certain girl (f)y
who having, at different times, difcharg'd many pounds of pus by (tool, had
a great quantity of the fame purulent matter in many abfeefles of the liver,
in thofe duels, and in that inteftine.
Thefe things then being granted, and as we have frequent, and evident,
examples of a fimilar circumflance in the kidnies, from whence the ureters
transfer pus and blood to the liver, I cannot help being furpriz'd, that fome
very learned men fhould, neverthelefs, fometimes feem fo far forgetful of this
open paffage from the liver, as to afiert that the mefentcric veins " often
" produce purulent diarrhoeas, and carry out the corrupted fubftance of
" the liver," as if thefe velTels convey'd humours, from the liver, to the in-
teflines, and not from the inteflines to the liver •, and that others hold it im-
pofTible to conceive, how a perfon could vomit blood, and difcharge it by
ltool, without any mark of injury in the ftomach, when, at the fame time^
they are not ignorant that in each lobe of his liver, which was very much,
enlarg'd, a confiderable abfeefs was found.
But let us return to the obfervations of Valfalva, which I have not yet
publifh'd •, and to thofe two relating to the liver, which I have defcrib'd
above, let me add as many which relate to the fpleen.
1 1. A young man of about twenty years of age, having, from an original
flrength, and firmnefs of conftitution, degenerated into the flate of a Vale-
tudinarian, for two years paft, attributed this change in his health to hunt-
ing, and dancing, and to other things of that kind, which he had indulg'd
himfelf greatly in the practice of, and to the effect: of the bufinefs by which
(d) N. 10, (f) Eph. n. c. dec, 3. a. 4. obf. 73.
(e) N. 6.
he
K)o Book III. Of dire Difeafes of the Belly.
he hia livelihood •, for he was by trade a fkx-drefier. He was beco
pallid in his countenance, and complain'd, according to the cuflom of hypo-
chondriac pcrlbns, of flight diforders of the belly, and thorax, which recur'd
now and then. At length, in the fummcr of the year 1688, a large and
hard tumour diicover'd itfelf in the left hypochondrium, with a fenfe of
weight, and a difficulty of refpiration in walking. To thefe fymptoms was,
fuddenly, added a large vomiting of blood, with a great lofsof ftrength, an
increafe of tumour, and a fever. By the afTiftance of remedies he was freed,
on the firft days, from the vomiting, and after that from the fever •, and hav-
ing us'd chalybeates for the three -fucceeding months, the hardnefs of the
tumour was alio remov'd : yet it continued equally large, with a pallid, and,
as it were, aimoft citron colour of the countenance.
But in the month of January, the vomiting of blood returning two or
three times, he was feiz'd with a violent fever, attended with a hard and
quick, though at die fame time fmall pulie, a pain, weight, and tenfion, of
both the hypochondria, and an inextinguifhable thirff. However, on the
ninth, or eleventh day, of the fever, he was taken off by a very placid kind
of death.
The body biing difTected, it was amazing what a fmall quantity of blood
remain'd in all the veffels. And, for this reafon, the vifcera of the belly
attracted the eyes by an unufual palenefs, and aimoft whitenefs, except the
ipleen which preferv'd its natural colour-, but this vifcus was fomuch increas'd,
as to exceed the liver in bulk, and weigh four pounds and a half. Yet it was
not harder than it generally is, except that on its convex furface, in one or
two places, was contain'd, deep within its furface, a fubftance of a very folid
nature, of the bignefs of a large nut. In the trunk of the fplenic vein, polypou*
concretions lay hid, which divided themfelves, together with the branches of
that vein, in a very elegant manner, even within the fpleen. The liver was
very pale, except that here and there it was mark'd with black fpots. The
gall-bladder, which was more pale than the liver, and even whitifh, contain'd
a little bile of a very dilute colour, a fimilar bile to which was not wanting
in the fundus of the flomach. The other parts of the belly were found.
In the thorax the lungs on their anterior furface were pale •, but on the
back-part they appear'd inflam'd, and were of a black colour, inclining to
purple: but, when cut into, they dilcharg'd a great quantity of frothy fe-
rum. In the right ventricle of the heart was only a fmall polypous concre-
.tion ; and in the left only a beginning thereof.
12. A great number of remarks might be made upon this hiftory. But a
regard mult be had to brevity, and therefore many things mull remain un-
dilculs'd. The large, and frequently-repeated, vomiting of blood in this
young man would have been eafily accounted for, at the time when it was not
doubted, but any thing might be fent from the Ipleen into the flomach, by
the vein which is call'd vas breve. But after that the circulation of the blood,
and experiments, have taught differently, the circumftance requires quite a
different explication •, as, for inflance, if we fay, that in proportion as lefs
blood can be brought by the caeliac artery into the obflructed Ipleen, fo
much the more mule be carried through the other branches of the fame ar-
tery to the flomach, or that the return of the blood from the flomach,
1 through
Letter XXXVI. Article 12. 191
through die vas breve is impeded by the tumefaction of the fpleen, which
frequently, and greatly comprefics this veffel, betwixt itfelf and the dilated
ftomach ; lb that by 0:1c or the other of thele hypothefes, or any other of a
ir hind, it may be underftood, how the blood can open an exit for itfelf,
from the over-diftended veffels, into the cavity of the ftomach, which is ai-
re uh particularly difpos'd to fuch a rupture.
Nor will it I fuppol'e feem to be any objection with you, that the (lomach
of this young man has been laid to be found; for you will imagine that the
blood had been difcharg'd by a great number of orifices, that were very
fmall, into this vifcus, which was probably furnifh'd with very lax fibres.
But if you examine the ancients themlelves, or thole who continued for
fomc time to be their fectaries, and look into the diffec/tions made by them,
and collected in the Sepulchretum (g), of fuch patients as had labour'd
under a diforder of the fpleen, and a vomiting of blood at the lame time,
you will find only one f&), which fhows any veffel to have been found mar
nifellly open in the ftomach. This was written by Riolanus, in the fecond
book of his Anthropograhia there pointed out, yet not in the fifteenth chap*
ter, but in the feventeenth, and about the end. To whom I fhall readily
give credit in the affair, but as I juft now explain'd it, in regard to the
vas breve, which was dilated to the thicknefs of a little finger : I will alfo
believe, if you pleafe, that he found the fame veffel open'd into the ftomach;
although I fee that he is there much difpos'd to magnify thofe things which
confirm his own opinion.
For I omit that, when fj caking of him, who, as you have it in the fifth
book- of the Epidemics, was fuftbeated by a vomiting of blood, and faying
" that a great quantity of blood had come forth at the fpleen and down-
Ci wards," he adds nothing in relation to the proper interpretation of thefe
words ; as if he chofe rather they fhould be fo underftood, as to relate to
the drfcharge of blood within the belly, (which the very ancient author of
that book could not have feen, as it was not ufual then to difiec"r. human
bodies l rather than to very led fpots in the fkin, appearing, according to the
interpretation of Vallefius (i), in the region of the fpleen, and beneath it.
I therefore omit this. But I can by no means pafs by his faying, that in
the body of cardinal Cibo, who died after the fame kind of vomiting, " Val-
-' vcrda had remark'd (in the fifth chapter of the fixth book) that by com-
" prefTing the fpleen, the ftomach was fill'd with blood, which was carried
*' thither by the vas breve."
For Columbus, who had diffected the body, has not hinted any-thing of
this experiment, as he has faid nothing more of the diffeCtion, than what is
read in the Sepulchretum (k) : and Valverdus, who has fpoken of it, has
made ufe of fuch words, that you cannot properly understand, whether the
ftomach " was turgid with blood " internally, or externally, when the fpleen
was comprefs'd ; and indeed Sanclorius, who had infpeded both of the au-
thors, underftood them fo as to write what you will fee in the fcholium, fub-
(g) L. 3. f. 8. obf. 71. & feq. (0 Comment, in eum locum, n. 37.
Obf. 7 j. (,;•) Obf. cit. 73. §.2.
join'd
192 Book III. Of Difeafes of the Belly.
joinM to that obfervation of Columbus : " while the region of the fpleen
" was comprefs'd, the blood regurgitated to the orifice of the ftomach."
Yet many bodies, although they were difledled after very great, and fatal,
vomitings of a bloody humour, or even of blood itfelf, have mown nofiVn of
an open, or eroded, vefTel in the ftomach ; and even the vas breve, notwith-
ftanding the fpleen was much bigger than in its natural fize, was extremely
fmall, and the roots of it, though they reach'd to the external coats of the
ftomach indeed, yet fcarcely reach'd to the internal : obiervations of which
kind you may find even in the Sepulchretum (I).
Wherefore, the blood is either brought from the inteftines, into which it
had burft, or through the biliary vefTels, from the liver, which the celebrated
Van Swieten (m) thought to be the more probable ; as, having examin'd with
great care all the vifcera of the belly in the body of a perfon who died of a
diforder of this kind, he could no where find any appearance of a ruptur'd
vefTel, nor any confiderable injury of any kind.
Indeed, there is alfo extant an obfervation of the celebrated Budseus (n),
which I have already pointed out, in a woman, in whom, after having
vomited a great quantity of matter, fimilar to grumous and corrupted blood,
although fhe had the vas breve full of the fame kind of matter, and almoft
equal to a finger in thicknels, yet the fubftance of the ftomach was without
any confpicuous veins, and the gall-bladder was enlarg'd, and turgid with
the fame matter, fo that it was eafy to perceive, from whence this matter had
come into the ftomach, which even then contain'd a large quantity.
But I would not have you fuppofe from hence, that it is my opinion
blood can never burft into the ftomach, from the vas breve, in confequence
of the direction of the blood being preternaturally chang'd for a time. For
it does not efcape me what Georg. Wolffg. Wedelius (o) has faid was found
in a matron, after a vomiting of blood ; what Jo. Dan. Dolasus (p) in a girl ;
what Stangius and Hillerus, jointly, according to Hoffmann (q), in a young
man : the laft of which obiervations, I have taken notice of to you elfewhere :
and the two firft I imagine are the fame that 1 remember to have read in
Stahl (r). In each of thefe bodies the fpleen was either larger, or harder,
than it naturally is : the vas breve was alio either thicker, or in part turgid
with blood, or at leaft confpicuous by its black colour, in the inlide of the
ftomach, and had its branches there ruptur'd, or fome one of them fo far
pervious into the ftomach as to admit a probe by that pafiage, or flatus,
or even blood, when this vefTel was gently comprefs'd.
Yet although any perfon, who is not ignorant how eafily either a probe,
or flatus, or impelFd humours, may open to themfelves a pafiage, after
death, through the lax coats of the diftended branches of the vefTels, which
was not before open, will perhaps be in fome doubt as to thefe obiervations ;
yet you are at liberty, for me, to admit of them, fo you do but remember
that they were few, when compar'd with the others : and that we cannot,
(/) In addit. ad. cit. fed. 8. obf. n. & 13. (/>) Earund. dec. 3. a. 5. & 6. cbf. 257.
. 3. obi
nalor. :
therefore,
(m) Comment, in Boer. aph. §-950. (y) Medic, rat. t. 4. p. 2. f. 1. c. 3. obf. 2
[») Eph. n. c. cent. 1. & 2. obf. 105. (>■) Differc. de vena port, porta malor. f. 3,
{0) Earund. dec. 1. a. 9. obf. 20.
Letter XXXVI. Article 13. 193
therefore, readily aflert with YVcdelius (j), " that a bloody vomiting mod
" frequently arifes from a preternatural opening of the vas breve." And a]
though he ihould anlwer in regard to every one, according to what he ob-
ferv'd in a young ftudent, that the vomiting of blood returns, chiefly, at
the time when the patient lies on his right fide, and that therefore it was
necefiary for him to lie on the left fide, as he had ordcr'd ; would it from
thence follow that the blood came forth from the vas breve, as if no other
vefiels be fides this went to the left fide of the ftomach*?
But whether thefe, or any other paffages, for the blood, evidently lie open
into the ftomach, at that time, or, which is generally the cafe, no pafiages at
all are open'd -, for you will even read in the commentaries of the famous
Academy of Petersburg (7), of a man who was carried oft* by a fudden death,
whole iloniach was found quite full of coagulated blood, and yet " per-
" fec~tly found," whereas " in the Iplcen, on the contrary, were found evident
tc marks of putrefaction j" whether, therefore, paffages through which the
blood has been dilcharg'd, do, or do not, manifeftly appear, you will always
explain, after fome of the methods which have been hinted at by me, or by
others, or at lead after fome fimilar method, not only the obfervations
that I have taken notice of, but alio thofe which occur in this fixteenth feclion
of the Sepulchretum («), of the fpleen having become more than once tu-
mid, but decreafing after a very large vomiting of bloody ferum, or blood j
and to thefe you may add that which Jo. Maurice Hoffmann (x) has pub-
lifh'd, from the papers of his father: although where it is not well-afcertain'd
by direction, what part is difeas'd, or what part is found, the fault may be
unjuftly attributed to the fpleen, which ought to be thrown upon fome other
part that is near it, or even upon the ftomach itfelf.
13. You may enquire here, why therefore in the young man in queftion,
whole fpleen, without doubt, was not free from difeafe, not only this vifcus
had not its tumour diminifh'd by a large vomiting of blood, but even in-
creas'd ? To which may be anfwer'd, that a great lofs of ftrength through
the whole body, from a violent profufion of blood, being added to the great
laxity of this vifcus, which was already become very infirm, the blood could
not be propell'd, and carried through it, but with great difficulty, efpecially
as it was become more inert from this profufion j and that therefore it was
under a neceffity of ftagnating more in the fpleen, by which that vifcus be-
came more and more relax'd. But it may feem much more furprizing, as the
vomiting of blood return'd two or three times, in the latter end of the dif-
eafe, how fo violent a fever could follow thefe vomitings, and be attended
with thofe figns which feem'd to fignify fome inflammation in the hypo-
chondria, of which, perhaps, thefe red fpots, diftinguilhing the liver here
and there, were tokens.
For the blood which remain'd in all the vefiels, was in fo fmall a quantity,
and had fuch an inertia as you would naturally fuppofe to be the confe-
rence of thofe haemorrhages, as the difie&ion demonftrates. And not
Clt.
(s) Obf. 20.
(/) Tom. 1.
(/.) In fchol. ad obf. 13 & 14.
Vol. II.
(x) Eph, n. c. cent. 9. & 10. in append, n.
1. obf. 6.
C c
to
1Q4 Book III. Of Difeafes of the Belly.
to fpeak of the appearance itfelf, the final! quantity of blood was argued from
the palenefs, and almoft whitenefs of the vifcera, and at the fame time the
inertia, especially when confidered in conjunction with the fmall quantity of
bile, which was of a colour extremely dilute. In the bodies or cachectic
perfons, I have often obferv'd the cortex cerebri to be very pallid, and the
medulla to be much whiter than ufual, in confequence of the fanguiferous
vefitfs, which go thereto, being fome empty, and fome lemipellucid, and
for that reafon fcarcely at all obstructing the enquiry of the eye, that fhoukl
endeavour to difcover, by looking externally, the parts whence the fmall
roots of the nerves go out from the trunk of the medulla, fo that I have
fometimes much wifh'd for brains of this kind, either in order to fee thefe
parts the more eafily, or to demonftrate them. However, whether the fmall
quantity of bile, and the very dilute colour of it, fignified that the more
acrid particles were contain'd in the blood, you may of yourfelf determine.
Tn the mean while, I will enquire what that was, or rather what that was not,
which the fpleen of this young man contain'd, deep within its fubftance, in
one or two places, of a more folid nature, and of the bignefs of a large
nut.
14. You have in one of the two fections of the Sepulchretum, which I firfc
mention'd, that is in the feventeenth, an obfervation (y) of the fpleen con-
taining, within its fubftance, a fteatoma confifting of an " adipofe matter,
" and of the bignefs of a nut." You have, in the fame fection, many obferva-
tions of the fpleen being become in part cartilaginous, or in part bony, or
even, as Pechlinus (z) afferts, ftony, to which you may join other obferva-
tions, not only from the preceding fection (a), but alfo from the firft of the
former book (b). But I believe that induration, which was found in thi:>
young man by Valfalva, was of neither kind ; for either of them would have
been eafily known : and he himfelf, when he had found in the old woman,,
of whom I fpoke to you in the twentieth letter (V), a bone within the exter-
nal part of the fpleen, did not in the lead hefitate to affirm, that he had'
found a certain bony body of a fpherical figure. I mould therefore imagine
that ic was of fome other kind, or if it was of either kind that I have fpoken
of, 1 mould fuppofe it was of the fecond,.that is the beginning of a bony or
ftony concretion, rather than of the firft.
J;or this is much the more frequent in the fpleen, not only as a great-
number of obfervations, pointed out in the Sepulchretum, mow, but as
others alfo, which are fcatter'd up and down, in anatomical writers, and are
eafily to be found, confirm. Wherefore, you. will find a great number, in.
like manner, in my letters which I have already fent (d), or which I mal!.
lend hereafter. However, I would not deny but this has been more fre-
qu ferv'd in old men, than in young, and likewife in the coat of that"
, rather than within the fubftance of it. Kor in the coat, or at lead.
on 'the laTfurface, after thofe who firft. obferv'd thefe appearances, as..
obf. 2.
i. & fchol."
. iuit. obf. 51. & fchol .
(c) N.41.
(./; Eplft. -.
epilt. 24.. n. 18.
n. 9. k 1 1. epift. 10. n. 19.
Andernocus
Letter XXXVI. Article 1 5, ijj
Andemacus (0> Vcfalius £/), and Columbus (g)y they have continued chiefly
to be Icen.
Yet this appearance has even been feen, (bmetimes, in young men, as by !
irated Fantonus (i»), and by myfelf(i): nor are obfervations wanting,
which lliow it to have exifted within the coat likewife. For Carolus Stepha-
nus (/(•) formerly admoniuYd, that it was heceflary to cut deep into the fub«
dance of the Ipleen, " that we may fee whether there are any calculi in its
" fubftance, as they fometimes have been found •," and you will read here
in the Sepulchretum(/), that a (tone, of the bignefs of a chefnut, " had been
" found in the fpleen of a beautiful young woman :" and in the eighteenth
fection (;«), that the ipleen, which was immoderately enlarg*d, " was full of
M very white (tones-," and in another 0/), " that it Contain'd many (tones ;"
to omit mentioning others taken notice of by Lentilius (0), and among thefe,
" two pretty large (tones, befides many others which accompanied them :"
and I myfelf will, on another occafion, defcribe to you a cafe, in which I
found a bony body going inwards, from the coat of the Ipleen, that was
alio bony ; and to this clafs I fhould likewife fuppofe, that, which Ijult now
raid was feen by Valfalva, in the old woman, was to be refer'd. And what
will you fay to this, that Littre (p) fhow'd to the Royal Academy of Sci-
ences at Paris, not only the " external membrane," as fome write, but the
whole fpleen of a certain old man become bony : and in the Mufaeum of this
univerfity, we have another, taken out of a body which was publicly diflected
in the college, before the beginning of the prefent century.
1 5. And as this fpleen has hitherto been defcrib'd by no body, I hope it will
not be difagreeable to you, if I give you the account of it. As I have, by the
confent of the celebrated Valiifneri the younger, who is governor of the Mu-
faeum, diligently examined it, as far as could be done externally. It is feven inches
long, and four inches broad, in its broadeft part, and at one extremity more than
two inches broad; for with the other it terminates in an angle: in one place it is
as thick as the little finger, in other places lefs by one half, and in many places,
but efpecially at the borders, much thinner. It is of an irregular figure, and
curv'd longitudinally : of an unequal and tuberous furface, yet more fo
on its concave, than on its convex part. Almoft' every where about the edges
are to be feen the dried remains of the membranous coat : thefe remaining
parts go from thence to each furface, but molt evidently to the hollow fur-
face, which is (till evidently inverted with its membrane, and for that reafon
appears of a yellow colour inclining very much to a brown; but the convex
furface is of a yellow colour inclining to white, if you except fome places in
•which the membrane remains, juft as it does on the hojlow furface. And it
is probable that when they pull'd away the fpleen from the diaphragm, to
which it adher'd very clofely, they tore the membrane away from the convex
(t) Apud. Bauhin, theatr. anat. I. I. c. 43. "(/) Seft. 16. obf. 20.
in adnot. (w) Obf. 22.
(/) De fabr. corp. hurc. 1. ;. c. 9. (») Obf. 25. §. 9.
(g) De re anat. 1. 15. (0) Eph. n. c. dec. 2. a. 7. obf. 13S.
(b) De obf. med. anat. ep. 8. n. 10. (/) Hilt, de l'acad. r. des fc. a. 1700. obiWv.
(/) Epift. 24. n. 18. anat. 7.
(k) De ditfetf. part. corp. hum. 1. 3. c. 40.
ubi de bene.
C c 2 furface
196 Book III. Of Difeafes of the Belly.
furface of that vifcus, fo as to leave it almoftuniverfally fix'd to the diaphragm,
and in fome places even univerfally, and at the fame tine, fome lamellae of
the indurated fpleen which coher'd to the membrane in thole parts ; and it is
probable that from hence was the origin of certain oblong hiatufies, and fora-
mina, of which there is fcarcely any on the hollow furface, as there is nor.
the leaft trace of thofe places through which the vefiels formerly enttr'd.
If you look at thefe hiatufies, you perceive that this fpleen is not every
where folid •, you even fee that it is cavernous, and empty, in many places ;
fo that it is not at all furprizing, it fhould weigh no more than ten drachms :
although that Hone, which I mention'd juft now (q), as being found in the
fpleen, of the bignefs of a chefnut, was " of the weight of two ounces and
" a half, and one drachm." For this was made up of laminae, like egg-
fhells, wrap'd over one another, " in the form of a cruft ;*' lo that no empty
fpaces were interpos'd, as in this Paduan fpleen, and perhaps alio in that Pa-
rifian fpleen, the weight of which we know to have been an ounce and a half,
but are ignorant of the dimensions.
It is alfo known, in what kind of man this fpleen was found, that is in a
man who had not been fubject to diforders, which are fupposM to have a re-
ference to the fpleen •, and of what fubftance it feem'd to confift, that is of a
ftony fubftance. But in regard to ours the latter circumftance is doubt-
ful •, and the former, as I have heard from the fon of my predecefibr, who
had been prefent at the difiecliion, was quite different. For the body, from
whence it was taken, was that of a porter, and not an old man, who had
not only been weaken'd by dreadful and incurable pains in the region of the
fpleen, but had even been oblig'd thereby to enter into this hofpital, where
he died.
But in regard to the fubftance of this fpleen, although Vallifneri the el-
der, to whom it had been laft given, wrote upon it, with his own hand,
thefe words milza ojfeffatta d'uomo, that is to fay, " the fpleen of a man offi-
*' fied :" and although fome fmall parts of it, which are protuberant on the
hollow furface, feem to be bony, yet when you infpect the other furface,
you will certainly think that it would have been more proper, if he had
made ufe of the fame word here alfo, which he often made ufe of in regard to
the brain of an ox, which was fuppos'd to be flony (r), and had written offec-
lapideous upon it, which I take for granted he would have done, if he could
have beftow'd as much time and labour upon this, as he beftow'd upon that.
But it might be more eafy for Lanzonus (s) to determine upon a fimilar ap-
pearance •, for he having found in a blackfmith, who was five and fifty years
of age, of a melancholic temper, and who died of a quartan fever, among
other marks of difeafe, the fpleen fo hard that it did not yield to the knife,
but when " ftruck with the hammer, flew afunder into three feparate parts
" like a ftone " did not in the leaft hefitate to pronounce that it was " pe-
" trified."
16. And, indeed, I have often before infpected, and now particularly,
whilft I write thefe things to you, I have under inflection, a membrane of four
(q) N. 14. (/) Eph. n. c. cent. 9. obf. 7.
(0 Confideraz. int. al. crcduto ccrvello dl
fcue impietr..
inches
Letter XXXVI. Article 16.
'97
inches in length, and two inches in breadth, which was taken from the- ion-
vex furface of a human fpleen in my prefcnee, and by my order. This
feems to be almoil wholly convened into flat and, thin laminae, which whe-
ther you confider them on the external, or the internal furface, you imme-
diately perceive to be entirely bony, without the leaft occafion for doubt.
But betwixt them, and, in part, out of them, grow imall tubercles exter-
nally ; but internally larger tubercles lie upon them, of an unequal and gra-
nulated furface, which went down within the fubltance of the fpleen to the
depth of half an inch: and thefe feem to be a kind of excreicences, as if
from a juice oi a middle nature betwixt bone, and calculus, which had been
elf us'd and concreted. Of which ambiguous nature that fubltance feems to
me in great meafure to be, irom whence the fpleen that I have defcrib'd,
from the College Mufeum, became indurated. In examining of which, I
learn'd that what I had Conjectund from the membrane, which I juft now
fpoke of, and others, was certainly not always true, though perhaps fome-
times ; I mean that the converfion of the fpleen into a bony, or ftony nature,
begins in the coat, and, in general, in that part of it which invefts the con-
vex furface, and which is, for this reafon, fubject to the alternate pre flu re of
the diaphragm.
For as often as ever it happen'd to me to fee it, in that part, I have ken
it, and others have feen it there likewife, or at leafl all thefe, nearly, who
have faid in what particular part, of the inverting coat, they found the ap-
pearance-, for what Pechlinus (/) found on the oppofite furface, is rare : and
to this I fuppos'd that the monitum of Bofchas is to be refer'd, which is
likewife produe'd in the Sepulchretum («), of " the upper coat of the fpleen
*' where it is turn'd towards the mufcles of the abdomen, being become fo
" hard, that it feem'd to be a fcirrhus within the fubftance of the fpleen,"
though without reafon : as you will alfo readily fuppofe, that what the mofc
excellent Plancus (x) remark'd, in a nobleman far advane'd in age, that is to
fay an oflification " in the membrane of the fpleen," where it adher'd clofely
to the peritonaeum, or that which (y) others obferv'd in a woman of three
and thirty years of age, that is '* half the external furface" of the fame vif-
cus, " intirely chang'd into a cartilaginous nature," to be of the fame kind.
For as to the very fkilful Weiffius (z) finding the beginning of a change
of this kind, that is to fay, " a white, tendinous, and hardifii fubftance, up-
" on the back of the fpleen, and its middle furface, in an oblique and tranf-
" verfe direction;" or as to an old anonymous author, as you have it in the
celebrated Targioni (a), having found " fo great a hardnefs of the fpleen
" in two places, where it had adher'd to the ribs, that the part feem'd bony,
*' or at leaft cartilaginous, but very hard.;" you will be in little doubt, I
fuppofe, on determining that thefe are to be refer'd to the clafs fpoken of
above. I therefore conjeclur'd that the dilbrder was, afterwards, propagated
from that part of the coat, which covers the convex furface of the fpleen,
into the remaining parts of the coat, and that by this means the whole fpleen
ft J Obf. cit. fupra. ad n. 14,
(«) Seel, hac 17. obf. 21.
(jr) Epiit. de monftris.
(y) In commerc. littr. a. 1734. hebd. 29.
(s) Eta. 1740. hebd. 35.
' \a) Prima raccolta di offervaz. me.!.
was
1 98 Book lit. OF Difcafcs of the Belly.
was at length Unrounded, as Bauhin (b) found it, and, if I rightly under*
Hand, Col up bus alio (tj, and they in like manner t*&o arc here pointed out
in the fixteenth obfervation of the Sepulchretum. And that after this, the
indurated matter incteafing more and more, and pufhing inwardly all round
from the coat, comprefles the whole fubllance of the vilcus, deltroys it, and
fills up its place. Yet this, though it may fometimes happen, as I have laid,
certainly did not happen in the fpleen defcrib'd by me id) •, fince whatever
part of its coat remains (and a great part of it does remain) is not only not
bony, or flony, but is even, at this very time, offuch a nature, that when
moiilen'd externally •, for I have made the experiment in more than one place ;
itfelf, only, becomes foon after loft, juil as dried membranes are wont
to do.
But thus far on this fubjecT. Now let us go on to another obfervation of
Valialva, which is one of thole that relate to the fpleen.
17. A woman of eight and twenty years of age, of a (lender make, being
married, but not having born children, had been formerly troubled with a
•chronic fever, which had left the fpleen lb much increas'd in its bulk, that a
tumour of this region was very evidently felt : fhe alfo kept her palifh com-
plexion, and was fometimes taken with a fever, which began with a rigor,
and continu'd fome days. As fhe had ceas'd to have a difcharge of men-
llruous blood, for two years pad, fhe loon after was troubled with a cuta-
neous, but obflinate ulcer, of the left leg : at the fide of which ulcer, the
leg fwelling afterwards, an abfeefs was form'd. This abfeefs, although it had
been exceedingly well cleans'd, and feem'd to be coming to a cicatrix, yet
when the time was at hand that the menftrua fhould, according to their re-
gular courfe, have been difcharg'd, the ulcer was irritated, increas'd, and
emitted a much larger quantity of ferous ichor •, and on the contrary the far-
ther it was paft the time of menftruation, the lefs was the ulcer irritated,
and the lefs matter was difcharg'd. At one of thefe very times therefore,
when, on the preceding day, not only a lmall quantity of ichor, but fuch as
had a flrong fmell, had been difcharg'd, and no new marks of death being
at hand, had come on ; behold fhe was oblig'd, early in the morning, to fie
upright in her bed, and, turning herfelf to one fide and to the other, com-
plain'd fo much of a flreightnefs of the prascordia, and of a very great anx-
iety at her cheft, that fometimes fhe could fcarcely utter a word, and fpat
up a great quantity of frothy matter, and matter that was tindtur'd with
blood : and thus within an hour fhe died.
The cavity of the belly was fill'd, almofl univerfally, on the left fide with
the fpleen, which was fo much increas'd in its bulk, and efpecially in the
longitudinal direction, that it weigh'd eight pounds and a half. The inter-
nal parts, of this vilcus, did not feem to differ from their natural conftitu-
tion : externally, both the fanguiferous, and lymphatic, veflels appear'd en-
larg'd, fo that the lymphatics were difcover'd up and down through the coat
Df the fpleen, and made a very beautiful appearance.
The fpermatic veffels contain'd blood of a violet colour-, fo th you might
perceive it had been retain'M there for a confiderable time. Tnf tefr.es were
he
ty . . cy) n. I5.
((.-) Locb fuyra indicatis ad n. ia-
almoft
Letter XXXVI. Article 1 8. 199
oofi wholly fcirrhous, To that no body need wonder at the woman's being
barren though young. In them was no veficle, if you except one in the left,
which was equal to the hair" of a iilberr, in its magnitude. This adhering
v clolcly to the fubftance of the teftis, and being diftinguiih'd with fan-
liferoua velUls, contained not a limpid, but a brownifh humour: which
being let our, a body of a yellow colour came into view, of the bignels of a
lentil, and almoft ot the form, but adhering to the velicle internally, fo as
to be lcarcely prominent : and this body was furrounded with fome very
i'mall globules, like a bulwark. And there were in the lame teftis fome other
bodies alio, which were of the fame colour, but not of the fame figure, nor
furniiTi'd with the fame lurrounding bulwark.
As to the thorax, every part therein was found, except that the lungs were
fuftus'd with a rednefs, and when cut into difcharg'd a great quantity of
matter, of the fame kind with that which 1 have faid the woman fpat up be-
fore her death.
1 8. Of barrennefs from a diforder of the ovaries, and of fuffbeation, from
deprav'd humours fuddenly falling upon the lungs, it is not the proper place
to treat here ; nor yet of married women, who do not bring children, being .
frequently, at length, liable to fome very great diforder ; nor of fome ab-
fcelTes in women, which, to all appearance, tend to a cicatrix, and are, ne-
verthelefs, frequently very difficult to be brought to it, and for this reafon,
that when the time returns, in which they are us'd to difcharge blood from
the uterus, the abfcelTes, which were already almoft heal'd, from the tur-
gefcency of the humours, and the motion thereof, which make their impe-
tus upon the whole body, and efpecially on the weaker parts, open afrefh,
and enlarge their dimensions, which I remember to have happen'd in the leg
of a noble matron, in particular, for many months fucceflively.
As we are, therefore, pafiing on to the confideration of other things, more
fuitable to the prefent occafion, we cannot avoid thinking of thofe long, and
obftinate fevers, which leave an enlargement of the fpleen behind them •, and '
of thofe ulcers of the legs which are the confequence of enlarg'd fpleens.
And that thofe ulcers have been, in fadt, join'd with fuch enlargements, even
fome of the letters, which I have fent to you, have fhewn (<?). But that the fame
has been obferv'd even from the mod ancient times, a palTage of the fecond
book of the Prorrhetica (f) teaches us : but take care how you read it, as it is
quoted here in the Sepulchretum (g\ in the fcholium to the ilxteenth obferva-
tion : " they who have an enlargement of the fpleen and haemorrhages, but
" not an ill fmell of the breath, will have foul ulcers of the tibia" -, for in.
the Greek the very words are (luj'ts ai/xo^hayjai y/voyrai, that is, " nor have a
" haemorrhage from any part," as others have more faithfully tranflated it :
therefore this opinion may, in fome meafure, be accommodated to that wo-
man, who had no eruption of blood from the uterus. And as fhe was of a.
flender habit, that would alio very well fuit with her cafe, which is imme-
diately fubjoin'd in the fame fcholium, from the obfervation of Spigelius, ,
'*■ that lean perfons are much more liable to tumefactions of the fpleen than.,
"■ fat perfons."
(<?) Epift. 4. d. 3c. Epift. 12. n. 2. (g) Sett. 16.
(A N. 42 v
But
200 Book III. Of Difeafes of the Belly.
But that thefe tumours are the confcquences of long-continu'd fevers is de-
monftrated to you by more than one of my letters (b), and confinr.'d by
more than oneobfervation (i), in the lection of the Sepulchretum. To which
you may add the obiervation of Chriftian Vater(£), made upon a ftudenr,
who, having been long afflicted with intermitting fevers, had his fpleen en-
larged to the fize of a man's head •, and, what is remark'd by that excellent
anatomical proieflbr WeifTius (/j, that " whenever" he lit en very large
fpleens, in the diflection of bodies, he generally found, upon inquiry, that
thefe perfons, when living, had labour'd under a violent fever at fome time
or other, " and that either an intermittent, or a fynocha continua :" to
omit at prefent what I have elfewhere taken notice of, from thofe celebrated
men Hoyerus, and Kramerus (m), of the infarction of the fpleen, after
intermittent chronic fevers, and particularly the quartan •, whofe obfervations
I could wifli were not confirm'd by examples amongft us, alio, of fevers of
that kind, but of fuch as are badly cur'd. And that fuch have been ob-
ferv'd by the ancient phyficians alio, thefe words of Hippocrates, or rather of
Polybus, are a proof (n)\ " this difeafe," that is the tumour of the fpleen,
•* happens when from fevers, and bad management of thefe fevers, bile or
" pituita, or both, have fallen upon the fpleen." For a vifcus which is of
itfelf lax, and cellular, and from which the return of the blood is flow, as it
is to pals through the liver, before it enters the vena cava, is extremely lia-
ble to tumours, elpecially if that little (hare of ftrength which it has origi-
nally, being weaken'd by a difeafe of long continuance, and the blood being
made inert and fluggifh, fome particles are left therein, which ought either
to be corrected, or thrown out of the body.
For the fluggifh motion of the blood being increas'd for thefe reafons,
while, like muddy water befide its channel, it is diverted into the cells of the
fpleen, it of courle depofits therein whatever corpufcles it may contain, which
are heavier and more grofs than the conftitution can bear, and by this means,
in part obftructing its own return, diftends the cells of this vifcus more and
more. And the more the whole fpleen is diftended by the diftention of the
cells, fo much the weaker it is, and for that reafon more liable to retain, in great
meaiure, thofe fluids which afterwards flow into it. For which reafon it
fometimes grows out in an incredible manner, fo that Aetius wrote even
formerly, that in fome perfons " the fpleen became contiguous to the groin,"
as you will read in the Scholium juft now pointed out •, except that as he is
there faid to have aflferted this in the feventh book, and as he compil'd, in
all, only four books of medicine collected from the ancients, each of which
were divided into four difcourfes, you muft look for it in the third book of
the Tetrabiblion, diicourie the fecond, chapter the fixteenth.
This blunder, and that which is ftill more confulerable in the fentence of
the Prorrhetica, were transfer'd into the Sepulchretum, by copying the words
of Diemerbroeck, and not turning to the authors he has quoted. For he
(£) Epift. iS. n. &. epift. 20. n. 2.30. 51. (/) Commerc. littr. a. 1745- hebd. 24. n. 1.
Epift. 31. n. 2. ad 7.
(/) 11. 13. 17. (m) Epift. 20. n. 52.
(X) Eph. n. c dec. 3. a. 9 & 10. obf. 165. (>/) Dc affettion. n. 21.
intro-
Letter XXXVI. Article 19, 20. 201
introdue'd afterwards, as I fuppofe (0), examples of very large fpleen s, in-
filling upon that which wcigh'd three and twenty poonds. lint Bofchus (p)t
if I underftand him properly, had afierted that a.fpleen had been found, by
his own father, which " weigh'd three and thirty pounds." But among the
obfervations that are more modern than thefe, although I do not remember to
have read any, in which the fpleen was fatd to come near to thai t, yet
thole which were publifh'd-from I lenricus Alb. Nicolai(j), and, before, from
Maurice Hoffmann (r), are by no means to be defpis'd. For the latter found
the fpleen to weigh fifteen poonds, and the former found it ftill half a
pound heavier; and both of them found it lb, that the diaphragm, on the
left fide, was driven to the fuperior ribs ; and Henricus fo that, at the fame
time, the fpleen hung down quite to the iliac region.
But Preuffius (s), in an infant, faw it extended in its magnitude, from the
left hypochondrium through the whole fide, quite to the pubes : and Vercel-
lonus (/) itill farther, that is to the lower part of the abdomen •, and as it could
not go beyond this boundary, it was reflected up again, and terminated be-
hind the uterus, in a mafs equal to the fize of a fill. It is true, that which
was found by Jo. David Mauchartus («), chang'd into the figure of a cone,
did not extend itfelt fo far •, yet it was large, as, being fix'd to the bafis of
the diaphragm, it was equal to a large human head in its bignefs : in its
weight, alio, it did not exceed four pounds with as many ounces ; but it
contain'd that which makes this obfervation very rare, that is to fay, fo great
a quantity of water within a kind of coat, like a hydatid, I fuppofe, which
had occupied all the internal parts of that vifcus, fo that Mauchartus did not
hefitate to call this dilbrder " a dropfy of the fpleen •," for four pints of water
burft forth therefrom.
Thus taking the word empyema in the mod extenfive fignification, you
may call that an empyema of the fpleen, which was found by Anthony de
Haen(tf), as that vifcus occur'd to him " full of pus, which was in great
" quantity, thick and white ;:' though by its inflammation it had before been
miitaken for a pleurify.
19. Now before I pafs on to other obfervations, from thefe of Valfalva's,
I am not willing to omit one from him, which will give you to underftand,
what vifcera befides thofe that naturally lie in the hypochondria, may there
create very great and even fatal uneafineffes-, efpecially if to the diforders of
thefe vifcera, although flight in appearance, a convulfion be added, which I
do not doubt was added in this cale.
20. A virgin was feiz'd with a violent vomiting and a fever. The for-
mer was appeas'd ; but the latter remain'd. A violent pain came on under
the falfe ribs, by which fhe was carried off within two days.
In the belly was found a very limpid ferum. The ftomach and the intef-
tines were very turgid from included air. Both of the kidnies were three
(0) Anat. 1. 1. c. 16. edit. Patav. (s) Earund. cent. 3. obf. u.
(j>) De facultat. anat. left. 2. (/) Earund. cent. 7. obf. 9.
(7) Commerc. litter, a. 1732. hebd. 33. n. 2. (») Earund. cent. 9. obf. 41.
ad 5. (*) Apud Svvieten comment, in Boerh. aph.
(>■) Eph. n. c. dec. 3. a. 9 & 10. in append. §. 958.
n. 1. obf. 5.
Vol. II. D d times
202 Book III. Of Difeafes of the Belly.
times bigger than their natural fize : but the left containM, betwixt its proper
membrane and the fubflance which lay beneath h, a little quantity or' a fa-
mous matter, and particularly on that part which was tu/n'd towards the fpleen.
In the cavity of the thorax was a little water. The lungs were ibund,
except that they were diftinguifh'd with black fpots, which wrre few in num-
ber. The pericardium was full of ferum. From the ventricles of the heart
fiow'd out a pretty fluid blood ; yet in the right, was the beginning of a po-
lypous concretion.
21. The increas'd bulk of the left kidney, and a dilbrder therein, at the
fame time, have more than once excited a tumour, or pain, in the hypo-
chondrium of the fame fide. And this may be learn'd from fome hiftories,
which are produe'd in thefe two fections of the Sepulchretum, as in the fix-
teenth, that which we have under article the fecond, of the twenty-fecond
obfervation, and in the feventeenth fection, two which are read under the
ninth article of the thirtieth obfervation, where Ballonius fays as follows :
" they did not fuppofe the pain to be nephritic, and yet it was fo ; but the
" fituation of the pain, and of the part, deceiv'd the practitioner." And
that this may fometimes happen on the right fide alfo, that hiftory which is
given in the fame thirtieth obfervation, in the firft place, demonftrates.
But that which is read lad in this obfervation fhows that the fame thing
may happen, not only from the parts which lie below, as the kidnies do, but
alfo by the parts which lie above ; as, for inftance, by the feptum tranf-
verfum being overloaded with a quantity of pus, and fore'd downwards :
for thus I conjecture that this hiftory ought to be explain'd, rather than by a
kind ofconfent, and affinity, as from the fame feptum, when deprefs'd by
the force of water, or a thick ferum, I have already fhown you (y), that a
hardnefs and pain have been brought on in the upper regions of the belly.
But now, not to recede from the kidnies, and from other parts which lie be-
neath the hypochondria, I think the obfervation of the celebrated Bonfig-
lius (z) ought to be added, in reading of which attentively, you will readily
perceive that an inveterate tumour, that had been formerly felt in the right
hypochondrium, was nothing elfe but the kidney, which, by being increas'd
more and more in its bulk, had at length fallen forwards from its natural
fituation into the iliac region, where it was found to be five times as big as
its natural fize.
But in regard to other parts, the celebrated Goekelius {a) will fliow you,
that from the omentum, having its bulk enlarg'd by a kind of fcirrhous fat-
nels, wherein the whole fpleen was enwrap'd, there was a tumour of fuch a
kind in the left hypochondrium, and with fuch a refiftance, that, for this
reafon, the tumour " exactly refembled afcirrhus" of the fpleen. And Schroc-
kius (<£), Hurterus (c), and Gerbezius (d), remark'd a tumour in the other
hypochondrium, together with a pain from a fcirrhus, which adher'd very
clofely to the inteftines, ileum and colon ; or from the colon being rais'd into
fuch a bulk, that by forcing itfelf againft.the ligaments of the liver, it drove
(j) Epift. 16. n. z6. & epift. 30. n. 30 {b) Et cent. 1 Sc 2. obf. 1S6.
k 31. (c) Ibid. obf. 134.
(z) N. c. cent. 9. obf. 4. (d) Et dec. 3. a. 7 & S. obf. 186.
[a) N. c. cent. 6. obf. 94. ad n. 7.
that
Letter XXXVI. Artiele 22, 23. 203
that vifens from its natural fitiratidn, towards the left hypochondrium : or a
pain only, which had been falfely imputed to the liver ; whereas it arofefrom
the mefrntory, which was, foon after, found to. be " eroded" uni
vilVus, nearly to the breadth of a ipan. But let us return to the diforders
proper to the vifcera which lie in the hypochondria.
22. However, as I have, much the more frequently, defcrib'd to you
obkrvations of the liver or fpleen being tumefied, it will, for that reaibn,
be fufficient here, to add to thofc which I have hitherto produe'd from Val-
falva, a few that are common to the tumours of both thefe vifcera.
2 >. A woolcomber of about forty years of age, came into the hofpital of
Padua for obfhuclions, as he himfelf laid, of the hypochondria. And that
he laid what was true, not only the bad colour of his face, and an infirm
ftate of health for a whole year already, and a flight fever, with which he
was often attack'd, and was not free from even at this very time, demonftrat-
ed, but the application of the hand to both hypochondria,- and chiefly to the
right, particularly confirm'd. When he feem'd to have reeeiv'd fome ad-
vantage from a courfe of remedies, behold he was feiz'd with an acute fever,
attended with figns of an internal inflammation of the thorax; and by that he
was carried off within ten or twelve days.
His body was brought into the college, that I might therefrom begin the
anatomical demonftrations of the year 1746: and as I examin'd the carcafe,
I law that it had a pretty clear appearance on the (kin, and was not alto-
gether lean, nor were the feet cedematous. The mufcles of the abdomen
being difledled, fcarcely at the diftance of two days from the patient's death,
and that in the month of January, were lax, and at their lower part inclin'd
to a greenifh colour. Yet the parts which were contain'd in the belly had a na-
tural appearance, if you except the following. The liver was immoderately
large •, lb that the very great magnitude of it immediately ftruck the eyes of eve-
ry one: and although it had not a bad colour externally, yet, internally, I ob-
ferv'd it to be of a paliih colour inclining to brown •, and, befides this, univerfally
mark'd with certain brown fpots, if you examin'd it with a ftedfaft and atten-
tive eye, either on the infide or the outfide ; and harder than it generally is,
which appear'd not only to the fingers, but was alio evident, by cutting into
it in feveral parts, and in feveral directions. And wh.le I was making thefe
incifions, I alfo obferv'd this circumftance, that no yellow point had appear'd
any where with any of the fe&ions of the veins, which is the general mark
of the fmall branches of the hepatic duel being cut tranfverfly, at the fame
time, whether this happen'd from thefe veffels having collaps'd in fome
meafure, from the fmall quantity of bile which was fecreted in the liver, or
rather becaufe the bile was of a more pale and dilute colour, and lefs apt to
tinge: and indeed, in the cyft was but a fmall quantity of bile, in proportion
to the bulk of the liver; the cyft itfelf was fmall, and had thin coats ; and the
bile inclin'd to a kind of cineritious colour.
The fpleen was twice as big as it naturally is in every dimenfion ; but in
other refpects, as far as I was able to judge, it was not to be found fault
with. The fplenic artery, from the origin to the termination, contrary to
the general appearance, had nothing tortuous in it in any part, nothing vari-
D d 2 cous,
204 Book III. Of Difeafes of the Belly.
cous, if I may io fpeak, excepting one place only, about the middle of its
length, where it was a little inflected.
On the mefentery had grown a hard body, of the bignefs of a fmall cher-
ry, and ahnoft of the figure, but unequal, and granulated, on its furface,
and of a middle nature betwixt bone and (lone : at one fide of this body was.
an arterial and venous branch, which ran very clofe to it, but did not enter
the fubftance, going out from thence to the interlines, which were at about
rwo inches diflance from this body. The ileum had that appendix, or diver-
ticulum, if you chufe rather to call it fo, which, as I have defcrib'd it in the
thirty-fourth letter (e), it will be fufficient to have flightly taken notice of
here. For it will be more to the preient purpofe, to obferve what other ap-
pearances I faw in the belly of this man. The external iliac vein, on the left
fide, near the opening of the internal, was hard, and yet not bony, as the
coats were only much thicken'd, in that part, for fome little extent : and
thefe coats being laid open, I faw, in the cavity of the vein, on one fide,
where it was perforated with no orifices, fmall chords protuberating, and a
kind of fmall valves.
But that deferves our attention flill more, which I faw in the kidnies, and
in their arteries, though it was rather unufual, than preternatural. Thefe
arteries were about nine inches in length, but narrow in proportion to this
large extent, except that they were rather wider in the upper extremities.
The length of. the finufTes, alfo, that receive and fend out the vefTels, was
unufual •, which was the more eafy to be taken notice of, as that whole
part of the fubflance of the kidnies was wanting, which fhould have made
up the anterior paries of the finufTes : and for this reafon, the larger of thole
branches, that convey the urine into the pelvis, were quite naked, and ex-
pos'd, and the fanguiferous vefTels were expos'd in all that part which is gene-
rally buried within the finus. But as two arteries, that is the inferior and
the fuperior, and as many veins went to each kidney, the veins went out from
the finufTes in fuch a manner, that the inferior afcended obliquely into the
fuperior, which was tranfverfe. And the arteries were not join'd with each
other, but the inferior, as well as the fuperior, was carried In a tranfverfe
direction, without any obliquity, for which reafon the inferior did not go to
the finus, but penetrated the kidney, almofl at its lower fide, beneath the
finus,
From this defcription you perceive, that both the inferior arteries mult
have arifen much lower than the arteries of the kidnies generally do : and
indeed they did arife from the aorta, at not more than the diflance of an
inch above the divifion into the iliacs ; and, what is, perhaps, much more
extraordinary, not from the fides of the aorta, but from the very middle of its
anterior furface, where they were fo near to each other, that their orifices
were but juft feparated, by a very thin feptum : coming out from thence, on
both fides, fimilar and equal, and being divided into no branches, before
their infertion, they were inferted as I have already defcrib'd ; whereas the
fuperior arteries, which were a little, but not' much, thicker than thefe, dif-
(<) N. iC.
fcr'd
Letter XXXVI. Article 24, 25. 205
f<pr*d neither in their origin, nor in their ramification, from thole which we
generally K
The inflection of other parts we could not profecute with the fame dili-
gence, as a better body was procur'd in the mean while. For which reafon
we did touch the head.
In the thorax, finally, we found the right lobe of the lungs annex'd to the
pleura, and hard : in the pericardium was a bloody water, to the quantity
of fome fpoonfuls : in the heart, two veins, which ran longitudinally upon
its pofterior furface, were turgid with blood, and in a manner vari-
cous.
24. Setting afide the confederation of the appearances which have no-
affinity to our prefent fubject, if we attend only to thoie that relate to the
tumefied fpleen, and to the tumefied and obstructed liver, the fplenic artery,
if we are to fuppofe that it was not without inflexions in its original forma-
tion, may feem to any one to have loft theie tortuous diverticula, while the
courfe of the arterial blood into the hard liver being obftructed, a greater
quantity of it was therefore necelfarily oblig'd to flow into the fplenic arte-
ry. And how much, when the liver is obftructed, the fmall arterial branches
within that vifcus are comprefs'd, and how much lefs a quantity of blood
they admit, is not only demonftrated by reafon, but fometimes alfo confirm'd
by evident obfervation. For the celebrated John Baptift Vulpius has'afFirm'd
to me, that he twice happen'd to find the trunk of the hepatic artery fo di-
lated, in a body where the liver was obftrudled, that he could introduce his
thumb into the cavity.
However, when the liver is thus affected, how eafily the conftitution dege-
nerates into a cachexy plainly appears in the man we fpeak of, from that
fmall quantity of difcolour'd bile, befides other things.
But if a very confiderable difeafe occupy the liver, we learn from a great
number of obfervations, that, frequently, the conftitution tends not only to
a cachexy, but even to a droply. Among which are worthy to be read, thofe
given by the celebrated Roftius (f), and Ufenbenzius (g) either on account of
the appearances found in the lcirrhous liver, or on account of its weight.
And to thefe you may alio add that which I ftiall immediately fubjoin.
25. A porter who feem'd to be of a middle age, and who had never been
attack'd with any difeafe, felt a very confiderable uneafinefs in his loins im-
mediately after lifting up a heavy load, which then oblig'd him to lie in bed
for two days, and made him fo weak, for the remaining part of his life, that
he could not now lift up even the weight of twenty pounds, without occa-
fioning a pain in his loins. A month after this accident he feem'd to him-
felf to hear the agitation of water in his belly, while he turn'd himfelf in bed,
and foon after to perceive a kind of body, as it were, afcending from the
hypogaftrium, into the fcrobiculus cordis, as it is call'd, which, ftoppi no-
there, caused the beginning of a very hard and pretty large tumour; with
which being afflicted, and with a flight fever, at the fame time, he came into
this hofpital, in the fifth month after his lifting that heavy load, and related
all thefe things which I have related to you.
(f) Aft. n. c. torn. 2. obf. 17S. (g) Et Cent. 9. obf. 27.
It
206 Book III. Of Difeafes of the Belly.
It was then certain, that he had a continual, though (light fever, which
was exacerbated in the night-time, that there was a tumour in the fcrobi-
culu3 cordis, and alio below the lower ribs, butefpecially on the right fide, and
that water was extravafated in the abdominal cavity. In the meanwhile this
extravafation increas'd, fo that when 1 happen'c! to have occafion to to up in-
to the hofpital, juft about a month from the time of his coming into it, and
being afk'd to feel the man's belly, I fcarcely perceiv'd 2ny particular tu-
mour elfewhere than in the fcrobiculus cordis, the abdominal cavity beincr fo
greatly diftended with water.
This tumour was very hard, and very unequal, but free from pain, even
when you preis'd upon it. I inquir'd whether it was troublefomc by its
weight ? whether there was any pain which was produe'd quite to the throat ?
and whether he was ever troubled with a cough ? To all which queries .he
patient anfwer'd in the negative. But when I afk'd him whether the i j-nour
increas'd at that time ? He not only anfwer'd negatively, but even aflerted
that it had fubfided, and was grown much lefs •, I fuppofe becaufe it was in
great meafure obfeur'd by the increafing water: and indeed, thole who had
felt it at other times could not perceive it to be diminifh'd. The face of the
man was fomewhat pale, but not yellow, nor of a cineritious colour ; and
even the white parts of the eyes, though I examin'd them very attentively,
did not appear to me to have the leaft yellownefs.
He lay, for the molt part, on his back : though he could lie upon either
fide. He was thirfty, but not to any great degree. He drew his breath
not quite freely, yet not with any great difficulty. Which circumftances I
remark'd with the more nicety, as 1 forefaw that the patient would die in a very
ihort time, and give us the opportunity of examining into the ftate of his vif-
cera, for which reafon I left him with an uncertain, and, in part, a fufpended
opinion, in regard to the univerfal feat of the tumour : and the patient, hav-
ing his pulle, at length, become very fmall, but preferving his fenfes per-
fectly to the very laft, died in a very placid manner, as he was fpeakino- to
fome perfons around him, in the beginning of April, in the year 1745, about
fourteen days after I had feen him.
But when the body was diffected, as it was on the following day, I was fo
much taken up with bufinefs of importance, that I could not attend. How-
ever, our Mediavia prefided at the diflection, in my room : from whom I
receiv'd this account on the fame day.
The body was lean, and no where, unlefs (lightly in the fcrotum, and (till
more (lightly in the feet, affected with an cedematous tumour. The belly
contain'd a great quantity of extravafated water, not of a difagreeable fmell,
not thick, nor turbid from a kind of thin membranes, as it were, fwimming
in it, but pellucid, yet inclining to that colour which we fee in oil of almonds.
The omentum being drawn up into the left hypochondrium, was found in-
deed, but of a greenifh colour inclining to brown. The ftomach was fmall and
contracted. The fpleen was twice as big as it naturally is, externally whitifh,
and internally had fome white fubftances, which, however, were not hard.
But the liver was by far the mod enlarg'd, fo that fome of thofe who were
prefent judg'd it to weigh about fourteen pounds. At leaft it occupied the
whole upper region of the belly, and the part which lay next thereto ante-
riorly,
Letter XXXVI. Article 26. 207
riorly, although it did not extend itfelf much below the ribs : and it had
grown out fo much towards the left fide, that the ligamcntum fufpenforium,
which was in other refpech pretty thick, being curv'd very much toward'.
that part, the umbilical fillurc was at the left fide of thecartilago enfirormis.
The whole liver was hard, and diftinguilh'd, in feveral places, with protube-
rating fpots, not narrower than a thumb's breadth, and thefe of a yellow co-
lour-, but in other rcfpe&s this vifeus was pallid. Thefe were the appearances
externally. And internally, if you except a few portions of the hepatic fub-
ftance intermix'd here and there, the whole vifeus confided of a fubftance,
which could not more eafiiy be cut afunder, than the mammary gland : this
fubftance was of a white colour, degenerating into yellow, and being prefs'd
leem'd to emit a kind of purulent ichor. Finally, the gall-bladder was ex-
ceedingly fmall.
26. When a black fmith, and, in like manner, a woman of whom the
celebrated Schmidius fpeaks (k), perceiv'd that fomething was broken within
them, not without a great, or a burning pain in the region of the liver,
from exerting themfelves in lifting up great burdens, it appear'd that nei-
ther of them was deceiv'd from what was found in the body of the fmith,
and from the circumftances which happen'd to the woman. But what our
porter hurt in his loins, in endeavouring to lift that burden, and what it was
which had impos'd upon him, lb as to appear like a body that was amend-
ing, although you may happen to conjecture properly, yet you cannot eafiiy
demonstrate. This, however, is certain, that as the diforder, and tumour,
of the liver increas'd, the water was increas'd in the belly, whether you fup-
pofe it to have been there before, in any preternatural quantity, or not.
For without doubt, the very fwelling, and weight, of the liver naturally prefs'd
upon the trunks of the vena-cava and venaportarum, and a great number of
iymphasducls, at the lame time, while the patient lay continually in a fupine
pofture of body, fo that out of fome of thefe being ruptur'd, or if they
were found, from the mere flagnation of the blood, more water would bt
pour'd out into the cavity of the belly.
A caufe was alfo added, which made the blood inert and fluggifb, I mean
the very great diforder which there was in the liver that was fcirrhous ; fo
that a bile was fecreted, which was not fit for the purpofes to which nature
intended it-, and this bile was in fmall quantity alfo, as the fmallnefs of the
cyft confirm'd : for which reafon neither good chyle, nor good blood, was
prepar'd. To this add, that the fpleen w-as preternaturally increas'd in its
bulk, and difeas'd in its internal conftitution : for although we cannot well
determine, what is the office of this vifeus in particular, yet we do not
doubt but it is, in general, of ufe in preparing one or both of thefe
humours. But why in this and the former man, and in fo many other ex-
amples, among which I could reckon not only that infant fpoken of by
Preuffius (/), but alfo the woman whofe hiftory is given by Portius (;«), if
the fame thing were not fo often feen in difTeclions -, why, I fay, the fpleen,
and the liver, were found tumid, I do not fuppofe, you will enquire, as you
very well remember from whence both thefe vifcera receive their blood.
(i) Commerc. litter, a. 1734. kebd. 34. (/«) Aft. erud. Lipf. a. 1704.. m. Soptembr.
(1J Obf. cit. fupra ad n. 18. in relat. ejus opufciucr.
4 For
208 Book III. Of Difeafes of the Belly.
For as both of them have their arterial blood from the fame caeliac artery,
which ever of the two fhall firft become tumid, and, for that reafon, admit
a lefs quantity of blood, muft, of confequence, force a greater influx into
the other. And as the liver receives its venous blood, in part, from the
fpleen, which we fuppofe to be intended for the purpofes of iecreting the
bile, there is no doubt but, if the liver is tumid, a greater quantity of blood
will remain in the fpleen : but if the fpleen be tumid, a blood of fuch a kind
will be fent therefrom, as is very unfit for going through the narrow pafiao-es
of the liver, and at the fame time, very improper for the fecretion of a well-
condition'd bile-, fo that if this be fecreted in a very vifcid, and thick ftate,
it will be in part obftructed in the liver, and will itfelf, confequently, increafe
the bulk thereof.
27. Thefe things, however, and fome others, which I have advanc'd, in
almoft the fame manner, in this letter, I would have you admit with fuch li-
mitations, as to fuppofe that the effects I have mention'd, may be the con-
fequences, if a proper time be given for thefe caufes to act, and there be no
impediment to their action j for they do often follow, as I have faid juft now,
but not always. Thus, to illuftrate our fuppofition by examples : Jacobus
Sylvius (n) difTected a ftone-cutter, who had an enlarg'd liver, which was
tender, and pale, like a liver that had been boil'd •, but his fpleen was of a
cineritious colour, had two fmall fcirrhi externally, and internally appear'd
as if it had been boil'd. Why was it not alfo enlarg'd ? Left you mould
happen to fuppofe this to have been owing merely to the tendernefs,
which, counteracting the effects of the increas'd weight of the liver, ftili
preferv'd an eafy paflage for the blood, through this vifcus •, know that there
were in this man, which is an extraordinary inftance, " three large branches,
" that went from the left emulgent vein, to the fpleen," through which,
as the circulation of the blood now teaches, a great part of the blood,
that otherwife muft have pafs'd with difficulty through the liver, and have
diftended the fpleen, by remaining there, was diverted into the emulgent
vein. But whether the fame three branches, by carrying away the blood
from the fpleen, fooner than the nature of that vifcus requires, and by de-
priving the liver of a part of that aftiftance, which it receives from the fpleen,
and which is necefiary to the full performance of its functions, contributed
any thing, in a long courfe of time, to thofe diforders which were obferv'd in
both the vifcera, you yourfelf will judge.
According to thofe things, which I have juft now faid, or thefe that I have
now hinted at, it will be eafy for you to explain other examples, as that of
Riolanus (0), and of Fantonus the father (p); in which cafes, the liver being
indurated, and increas'd in its fize, the fpleen was not only not larger than it
generally is, but was found to be fo extremely fmall, that it fcarcely weigh'd
an ounce, or that -the traces of it alone remain'd. For fuppofe that the
jpleen was diminifn'd, whatever the caufe of this might be; and you already
•perceive, how much more arterial blood muft, of courfe, have been fent to
the liver, and how little afiiftance, therefore, there muft have been given to
the fecretion of good bile.
(;.) Obferv. adjett. Ifagogi anat. (/) Obf. med. anat. 24.
(0) Anthropogr. 1. 2. c. 16.
c Or
Letter XXXVI. Article 28. 209
Or fuppofe, on the other hand, that the liver is increas'd in its bulk, from
fome caule or other, Co as 10 occupy the whole epigaftrium, as in the exam-
ple of Fantonus, and to thrall the ftomach clown into the umbilical region :
you will then cafily conceive, how both the fpleeh, which is a lore and lax
vifcus, and the fplenic artery, from whence it receives the blood by which it is
nourifh'd, preferv'd, extended, and dilated to a proper degree, may be at
the fame time comprefs'd : and as this artery pallcs under the pancreas,
being affix'd to it longitudinally, you lee evidently, how much it mult have
been preis'd upon, in the example given by Riolanus, in which the pancreas
was univerlally fcirrhous, and in its bulk, and weight, was equal to the
liver itfelf. For as to his finding remains or" the fplecn, in another body, of
the breadth of a finger-nail, this might, perhaps, have been owing to a
greater, and more long-conunu'd, compreffion of the fplenic artery, as lie-
there found the pancreas to be not only fcirrhous likewife, but even in-
durated like a cartilage.
28. However, to lay nothing of *the pancreas, and return to the fpleen,
and liver, 1 confefs there is (b much mutual commerce,- and connection, be-
twixt both thefe vifcera, that if one be difeas'd, in confequence of the other
being difeas'd, there is no reafon for furprize : but on the contrary there is
reafon to wonder, if a diforder be found in either of them only, as when you
read in the Sepulchretum (q) : " the liver was large, and in many places
" hard -, .... the remaining vifcera of the belly being in a natural ftate :"
or (r) " the liver was almoft without moifture, and pallid ; . . . . but the
" fpleen, and kidnies, had a natural appearance." Neverthelefs, even in a
long diforder, where a greater injury is found in the other vifcera, than in.
the liver, it by no means follows, that in this alfo the difeafe mult have
been of long Handing : which I would have to be underftood chiefly of
the fecond of the obfervations, juit now pointed out.
We mult take care, moreover, that we do not* now and then, take
fome appearances which have exiited from the original formation of the body,
for the caufes, or effects, ofdifeafes: of which kind I fhould fuppofe thofe
" feveral incifions" of the fpleen to have been, that are mention'd in this
feventcenth feCtion of the Sepulchretum, under obfervation the nineteenth,,
and which feem to be reckon'd among the morbid appearances, juft as I be-
lieve of thofe " chinks or fiffures of the liver," which are fometimes pro-
due'd, in the preceding feventeenth fedtion of the Sepulchretum, as the
caufes of a pain in the right hypochondrium." Blunders of this kind are
eafily refuted, by a frequent and attentive obfervation of the fiffures of both,
or of one, or other, of the vifcera, which molt frequently occur in bodies
of every kind, and not without fome utility, as I have faid in a former
work (s).
But, although a reafon could not be given for all the cafes, in which we
read of the found ftate of one of thefe vifcera, being join'd with the diforder
of the other, thefe would not be the only inltances, which feem to happen
fometimes contrary to expectation. For, not to quit the hiftory of the por-
(f) L. 3.f. 14. obf. 36, §. 4. CO F-piil. anat. 1. n. 35.
(>•) Ibia. obf. zQ.
Yql. IT. E e.
210 Book III. Of Difeafes of the Belly.
ter, it certainly does not very-well appear, why the patientdid not feel any un-
eafinefs from the weight of the liver being fo much increas'd : nor yet why,
among the fymptoms which I obferv'd to be a'ofent, fome, in particular,
could be abfent, in fo great a depravity of the liver. And without doubt,
we ought to take warning from hence, not to be too rafli and hafty in
pronouncing any thing for certain, by denying or affirming in fome cafes.
And indeed fome things occuj' in medicine, which are ftill more extraordinarv,
and furprizing, than thole I have juft now hinted at-, and which ought,
therefore, to render the phyfician more cautious, in forming a diagnofis,
and confequently in acting.
Two cafes of that kind I will, in this place, communicate to you, as I have
rccciv'd them from others, fince they will not be foreign to the prefent pur-
pole ; for they relate to a morbid ftate of the two vifcera, which lie in the left
hypochondrium, the fpleen, and the ftomach. Of the fpleen our Mediavia
obferv'd as follows, in the living body firft, and after that in the dead body,
about the end of the year 1735.
29. A man of a lean habit, among other diforders on account of which he
lay in this hofpital, had a tumour alio in the left loin, where this begins to
terminate in the outer fide of the body, under the loweft rib. This tumour
fometimes appear'd lefs, and fometimes bigger, to the eye that examin'd it,
yet never was very apparent at any time-, but it yielded to the hand that
prefs'd it, as if it contain'd a fluid. At length the man funk under his dif-
eafes.
The belly being open'd, it appear'd evidently from whence this tumour
arofe. For the lower part of the tumid, and very foft, fpleen reaching to
that place I have mention'd, and being, at one time more, and at another
time lefs, fore'd thither by the flatus of the ftomach, and inteflines, caus*d
fuch an appearance in this body, which, as I have faid, was very thin, as
might eafily have impos'd upon fome rafh and inconfiderate furgeon, to the
great detriment of the patient.
30. In the fecond book of the predictions (/), after many things that are
laid of thofe who have large fpleens, the following words are immediately
fuhjoin'd : " but if tumours fhould alfo come on in the fee:, they will even
" feem to have water. Yet it is neceifary to examine the belly and the
" loins likewife." I would have you fee, therefore, among thofe who have
interpreted the oracles cf Hippocrates, whether there is any one, by whom
the infpection of the loins is refer'd to thefe enlarg'd fpleens, the other fymp-
toms of which immediately precede.
But Peter de Marchettis, whom I have already commended, read to me a
cafe in the year 1730 (from a letter of a neighbouring phyfician, who was
very much efteem'd by each of us) which relates to the ftomach : the cafe
was as follows, the circumftances having been all very well-known to the phy-
fician who wrote, as they happen'd in the place where he refided.
31. A woman had a tumour form'd at the region of the ftomach, which
being examin'd bv the furgeon, feem'd to him to be coming forwards to fup-
(0 N- 4*-
puration -,
Letter XXXVI. Article 32. 211
Duration -, yet after having applied many things proper to haften the iuppur-
ation*, he, nevertheless, could not bring it thereto. Finally, this was the
iflbe of the cafe, that the tumour difappear*d, the fkin remaining contr.n
where the tumour had been in the form of' a cicatrix, notwithllanding it had
not difcharg'd any moifture. After this the woman conceiv'd, and the time
of utero-geftation, of delivery, and child-bed, being happily pafs'd over,
lhe being in gopd health and her milk flowing properly, as in a woman who
e Kick, and having now ic.ch'd beyond the third month from the time
of her delivery, flic or a fudden pcrcciv'd that a little moilture diftill'd from
that cicatricula. And on examining the moifture, found that it was the
wine which Hie had jull drank. She could alfo, if lhe endcavour'd to do it,
force out by this way fome of the pudding fhe had taken in. Yet the final
event of the diforder was that the wound was perfectly heal'd up, and the
woman continu'd to be in good health, as the phyfician who was interro-
gated by other letters from Marchetti, which he wrote with great friendlinefs,
in order to fatisfy me in regard to the cafe, afiur'd me.
32. You may alfo read many examples of the ftomach being perforated,
the foramen either lying hid within the cavity of the belly, or being open'd
externally, in the hiftory of a virgin who labour'd under this difeafe, for
feven and twenty years, publihYd by the celebrated Chriflian Wencker (u) -,
and thefe may be added to the Sepulchretum : for although it was not pof-
fible to cure any of thefe patients, it was polTible, however, to difTect them
all after death. But you will find a fuccefsful cafe, and not unlike that
which I defcrib'd to you juft now, in the programma which Etmullcjr the
ion added to his difTertation, intitled " de fragrandi pedis irfiemm aticne."
And as in this programma you may, at the fame time, fee every thing that
relates to the perfect cure of a flomach thus injur'd, fo that nothing fhall fall
out from thence into the cavity of the belly, I will add nothing farther to
this letter, which is already very long, except to entreat you to preferve your
ufual affection for me, and take care of your health.
(a) Argentorati a. 1743.
E e 2 LETTER
212 Book III. Of Difcafes of the Belly.
LETTER the THIRTY-SEVENTH
Treats of the Jaundice, and of bilious Calculi.
THE morbus regius, or jaundice, fo is frequently join'd with the dif-
orders of the liver, of which I particularly wrote to you in the lad
letter, that in the Sepulchretum, the eighteenth fedtion, which profefiedly
treats of this difeafe, is with great propriety immediately fubjoin'd to the two
fedtions which treat of thofe diforders. To the jaundice relates this obferva-
tion of our Valfalva.
2. A young prieft was feiz'd with the jaundice, a little after a kind of
perturbation of mind : this diforder was alio attended with a pain at the
region of the ftomach, and a vomiting, by means of which he threw up both
his food, and his medicines, frequently. After a day or two, the patient
was obferv'd to be unquiet, and in fome meafure ftupid, fo as to forget
every-thing that was related to him. The phyfician did not obferve any
fever, till the dole of the third day : at which time it difcoverd itfelf with
great violence, with a delirium, and convulfions of fuch a nature, that the
patient was oblig'd to gnaw every thing with his teeth, and by his great
ftrugglings almoft overcame the ftrength of thofe who were about him : be-
fides thefe, he was troubled with a vomiting of a darkifh-coloured matter. In
the morning a vein was open'd, from whence the blood rufh'd forth with
impetus: the ierum of which, when it receded from the coagulating part,
ting'd a linen rag, that was dip'd into it, of a yellow colour. The convul-
fion cea's'd : but the patient lay to all appearance afleep, icarcely mov'd him-
felf, and did but juft fhow that he felt the cupping-glafles which were ap-
plied to him. His refpirarion was almoft natural, except that it was fome-
times iufpirious. He died on the beginning of the fifth day.
The belly being open'd, the liver was found to be flaccid, and inclining
to a palifh colour: in the gall-bladder was a darkifh bile. In the ftomach
was matter of the fame kind with what he had thrown up, on the laftdays of
his diforder : on its internal coat, about the left orifice, were a kind of red
points, at lome little diftance from each other. And there were many very
lmall glands, in fcveral places throughout the belly, which were inflam'd by
ftagnating blood.
The thorax being open'd, the lungs were tumid with air, and free from
connexion with the pleura, if you except fome fmall membranous bands,
which
Letter XXXVII. Article 3, 4. 2*3
which had tied the left lobe to the pleura. In the pericardium was a little wa-
ter. In the ventricles of the heart was concreted blood.
The lkull being cut open, and the dura mater being incis'd, a little quantity
of ferum ilfued forth : in the interlaces of the fanguiferous veflels, which
creep through the dura mater, a kind of gelatinous concretion was obfcrv'd,
but in a very flight degree : the cerebrum was very lax, nor altogether of its
natural colour, which perhaps had been deprav'd by the tincture of the bile.
While the fpinal marrow was cut through, in the upper part of the verte-
bral tube, in order to take out the brain, from the external paries of this
medulla, a ferous matter llow'd for a considerable time, as if from a lymphae-
duel being cut through.
3. What effect; paflions of the mind may have in bringing on a jaundice,
is. not only demonstrated by frequent obfervations, in the practice of me-
dicine, but evidently confirm'd by the prefent. Nor will this be furprifing, to
thofe who confider how much the nerves confent with the paflions, and how
much power the fame nerves have, in affecting the fanguiferous, and excre-
tory veflels, and in affecting the internal fecretory organ, whatever that may
be, and conlequently in impeding, and vitiating, the fecretions, and excre-
tions, of the humours. Suppole, that in fome bodies the hepatic nerves
confent moft, or if other nerves confent alfo, yet that the veflels of die liver,
and the fecretory organ, yield more eafily to the action of the nerves-, and
you will immediately understand why a jaundice arifes in them, from the
paflions of the mind.
Thus in Hoffmann (a), you will read of a woman, in whom, " as often
" as ever from a preceeding commotion of mind .... new febrile pa-
*' roxyfms came on, the jaundice immediately return'd with all its fymp-
*' toms." And if you take into the account, certain difpolitions of the
blood, or of the matter of the bile, which is to be fecreted therefrom, or pf
the other vifcera, you will lb much the more eafily understand the affair, and
conceive of the origin of thofe very violent symptoms, which are fometimes
added to a jaundice, and bring on death much fooner than expected. All
which circumstances may not only be perceiv'd, in the obfervation that I
have given you of the prieft, but may alfo be illustrated, by examples that
are in great measure similar. The first of which was related to me, when I re-
sided at Bologna, for there it had happen'd, and that not many years before,
by grave and learned men, and confirm'd by Valfalva himfelf, who had been
prelent at the diffection.
4. A very ingenious young man who was fet apart for learning, and the
priests office, was greatly terrified by a fierce and violent man, who held a
mufket to his breast, unexpectedly, and threaten'd to (hoot him. The day
after he became icteric, and loon after that delirious fo as to know none of
his acquaintance, but cried out every now and then, oh vile man ! and then
being leiz'd with very great convulsive agitations, fo that he could fcarcely
be held by the hands of many perfons, he died within four and twenty hours
from the beginning; of his delirium.
The diffection of his body fhow'd nothing that was worthy of remark, except
(a) Medic, rat. t. 4. p. 4. c. 12. obf. 5*
that
214 Book III. Of the Difcafes of the Belly.
that the fanguiferous vefTels, which creep through the pia mater, were, for
the mod part, diftended with black blood.
5. This hiftory we might have put in the number of thofe which relate to
deliria, or even to convulfions. But becaufe the jaundice appear'd firft of
all the difordcrs which came on, in confequence of the fright, I chofe ra-
ther to give it you under this head. The jaundice feems to have been
brought on by a contraction of the hepatic nerves : and the matter of the
bile being, in great meafure, retain'd in the blood, becoming acrid, and
greatly afreCting the brain, as in a young man, and a man given to letters,
feems to have brought on all the other fymptoms.
6. We will not fearch after other examples, among medical writers,
which are to be compar'd, in many things, with '.he example of Vallalva
(£), as we have two here in the Sepi.lchretum (f), one of Ballonius, in a
young man, fon of the Count de Chaulney, and another of Guarinoni in the
Cardinal Sforza. This latter icteric patient had at firft no fever, but what
was latent, fo that the phyficians did not attend to it, till after it became
more violent, when being i'eiz'd with a flight delirium, and af;erwards with a
frefh increafe of fever, with a very great tofling of body, and not long after
with two fudden epileptic paroxyfms, and, finally, three days before death,
being attack'd with various convulfions, he was neverthelefs carried off
gradually, and gently •, the liver, and almoft all the other parts of the body,
being ting'd of a yellow colour, to a very great degree, and the lungs being
in the fame ftate, in which they are generally found, in thole who have been
long excruciated with a difficulty of breathing, at the time of their death.
But the young man, from a lively and good-natur'd difpofition, being
made morofe, and melancholic, and being fuddeniy i'eiz'd with the jaundice,
after fifteen days, when no fuch thing was thought of, gnafh'd with his
teeth, and was convuls'd in the night-, was in an extafy as it were, and after
great howlings and convulfions died : the brain being found in fuch a flate,
that the cauie of death did not feem to have been there, the lungs being very
much difeas'd, but the liver flill more, fo that it was uto^Xwotd as it were ;
for thus the word ought to be written, and thus it is written by Ballonius,
as you will fee by looking into his fecond book of the Epidemics, which is
quoted (JJ, not in page two hundred and forty four that is pointed out, but
in page two hundred and fifty eight ; and as this word fignifies greenifh, or
palifh, you plainly fee that this young man agreed with the prieft of Valfalva,
in this colour of his liver alfo. And they all agreed in that flupor of mind,
which Ballonius calls a kind of extafy, or trance, Guarinoni levis defipicntia
or a flight fuppreffion of the fenfes, and Hippocrates, or at leaft the authors
of the praediciiones (e), and coacse prasnotiones (f), jucopwo-ir, and have
taught to be bad " from a jaundice :" interpreters render it by the word
fatuitas, which fignifies a ftupidity, or dullnels, of the internal ienfes, who
are follow'd by Zachias, in an obfervation that confirms this, and is tran-
fer'd into the Sepulchretum («■).
(b) Supra n. 2. (e) L. 2. n. 4.
(<) Obf. 6. & in additam. obf. 5. (f) N. 2.
(d) Edition qua: una tunc erat, & diu fuit, (g) Obf. 7*
parii.enf.
But
Letter XXXVII. Article 7. 215
But if you enquire, why there was not a furious delirium in all theft pa-
tients, though there were convultions, there is no doubt but this may be ac-
counted for, and in lbme meafure from the different age of the patients, the
rent temperature and difpofition of the blood, bile, and vifcera. Thus
in the cardinal, the blood was fluid, and found without any consilium in any
part, of which kind Boerh a ) affirms it to be, in idteric bodies, fo that
u when taken from a vein it does r.ot coagulate:" but in the pried of Y.ii-
falva, it had not only been concreted, when taken away from the vein in a
proper veflel, but was alto found to be concreted in the ventricles of the
heart-, for which reatbn, the ftagnatfng blood appear' d about the domach,
in the form ot redifh points, and here and there throughout the belly, like
many fmall glands which were inflam'd : and that blood of this nature has
been fometimts found by anatomills, in the heart of other icteric patients,
the obfervation of Zachias, which I have already pointed out, and another
likewife of Bartholin, which you have here in the Sepulchretum alfo (i)9
fufRciently demondrate ; not to mention here my obfervation upon the pot-
ter, who was in great meafure icteric, and whom I have defcrib'd to you on
a former occafion (£), or another of Valfalva, on that icteric girl (/), which
i 1 ill more deferves our attention, becaule, though, except the mucous con-
cretion in the heart, the remaining part of the blood was fluid, yet when
expos'd to the air it coagulated.
But to this difpofition in the blood to concrete, other caufes mud be
added, both in this fluid itfelf, and in the brain, in order to bring on a de-
lirium. And yet it is of no great importance, if the brain, not even at this
time, nor when there were the mod violent convulfions, appears to be in-
jur'd. For that which was the cauie of delirium therein, may efcape the
penetration of the eyes : and from the nerves being irritated, even on the
out fide of the brain, or from an irritation on the fpinal marrow, which we
mult luppofe to have had this effect in that pried, horrible convulfions may
arife.
7. However, the brain was not found to be altogether uninjur'd, in that
body, whether you attend to that which was obferv'd in the difTection of the
meninges, or even the very colour of the brain, which was not entirely na-
tural, and was readily fuppos'd, by Valfalva, to have receiv'd a tincture
from the bile. For notwithdanding the fubdance of the brain is itfelf found
to be yellow, fometimes in this difeafe, I do not, however, remember to have
read many obfervations, wherein it was fo found, perhaps by reafon of the
extreme fmallncfs of the veffcls, which go to the internal fubdance of the
brain, in the fird place, and in the fecond place, perhaps on account of their
rarity. And this at lead I can fay, that fome time ago, when I had, ac-
cording to cudom, a great number of heads in the theatre, in order to give
the anatomical defcription and demondration of the brain, obferving a yel-
lownefs of the face, of the fkin in other parts, and of the membrana con-
junctiva of the eyes, in one of them, I inquir'd to whom it had belong'd,
and found that it was the head of a man who had been adhmatic, and jaun-
(<*) Prxleft. in inftit. §. 77 V
Obf. 24.
(/•) Epift. 7-n. 11.
(/) Epiit. ic. n. 7.
die'd,'
2i6 Book III. Of Difeafes of the Belly.
dic'd, and had died the day before : through the external furface of the pia
mater, I law, in federal parts, confiderable fpaces of a yellow colour, in-
clining to grccnifh ; yet foon after, when the brain was diflected, I found the
colour therein to be the fame as it naturally is.
Again, when a like occafion was offei'd afterwards, notwithftanding I
found the imall quantity of water, in the lateral ventricles of the brain, to
be of a yellowilh colour, and the plexus choroides fomewhat inclin'd to that
colour, and the pineal gland itfelf, in other refpects very fhort, and pretty
hard in its body, and having a Imall fubftance adhering to its bafis anteriorly,
not fandy, nor yellow, but white, and towards its upper part having fome-
thing in it like blood, or a fanguiferous vefTel ; I fay, notwithftanding I faw
this gland inclining from its ufual cineritious colour, to an obfeure kind of
yellow -y yet all the remaining parts, for I diflected them, preferv'd their na-
tive colour, fo that whatever was medullary, I found to be extremely white.
So alfo here in the Sepulchretum (m), after a long-continu'd jaundice, you
will fee that the fubftance of the brain was very white , although not only
the meninges, and particularly the dura mater, but the cranium alfo, exter-
nally, and, in part, internally likewife, was yellow.
For this difeafe fometimes tinges the very bones with a yellownefs, which,
as fome aflure us, can never be wafh'd out from the fceleton. How yellow
the bones were in an icteric foetus, the obfervation of Kerckringius fhows,
which you will alfo read here in the Sepulchretum (») : nor is it to be won-
der'd at ; as, inftead of blood, he found a yellow humour like gall, of the
fame kind with that which v/as found by Vefalius, in like manner, in Mar-
tellus a nobleman of Florence, as you would learn from this fame fection of
the Sepulchretum, if his diffection, which is given imperfectly twice over
(c), were once fully defcrib'd, as it is in another place (p).
However in all thefe places you fnould read Martellus, inftead of Mar-
cellus, which is falQy tranicrib'd : and fuppofe that Van Helmont (q), him-
felf, had lit on obfervations not unlike thefe, when in the mefenteric veins
of two icteric patients, he law that appearance, from whence he fuppos'd
w an excremental virus, or a yellow and ftercoreous cruor, or a yellow liquid
" excrement, the confequence of a fecond digeftion, which was preternaui-
" rally taken up into the veins, and difpers'd through the whole body," to
be the occafion of the jaundice ; whereas it was a bile, which, by reafon of
its having not been fecreted from the blood, in a proper proportion, either on
account of its great plenty, or on account of the difeafe of the liver, as in
Martellus, abounds at length, therein, to fo great a degree fometimes, that
the blood which is taken away, and the urine which is then difcharg'd, ap-
pear to be perfectly like each other (r) ; and that not only in perfons wdiere
the difeafe is to prove fatal, but even frequently in thofe who are to efcape (j),.
which happen'd to them, or, at leaft, to that icteric patient in whom, as
Baglivi (7) relates, " inftead of blood, yellow water only, fiow'd out from
" the noftrils, and from the cupping-glades, which were applied to the fca-
(;;;) Obf. 3. (r) Vid apud Hoffmann. ft;pra ad n. 3. cit
(n) Obf. 34. cap. 12. §.4.
(e) Obf. 8. §. 4. &obf. 20. (s) Ibid.
(p) L. 2. f. 11. obf. 36. §. 1. (/) De experim. circa bilcm.
(jl Vid. in hac Sepulchr. 18. feft, obf. z6.
5 " rifications;M
Letter XXXVII. Article 8. 217
" rifications," juft as we read in Lower (u) of the recovery of that young
mr.n, who, having had a large eff'ulion of blood from his noflrils, ah3 being
well-lupported, in the mean while, with broths, began at length to have a
fluid difeharg'd from the rupiur'd veifels, which was more like broth than
blood.
8. But among thefe parts which are obferv'd to be the mod eafily, and
molt frequently, ting'd with a yellow blood, are the adipofe membranes in
particular, and thole which are call'd coujunfliv* in the eyes. Valfalva
iupposM the fat to be the mod: prone of all the parts to contract the 1..'
like colour, where the ferum of the blood is only a little yellow. For he had
found the fat to be of this colour, in many who were not affected with the
rcgius morbus, and efpecially in three bodies, which he difiected almoft at
the fame time, that is to fay in a hydrocephalus patient, in a man who had
been wounded, and in another who had been carried off by an ardent fever.
But this yellownefs is lb obvious in the white of the eye, in patients la-
bouring under that difeafe, that the ancients feem to have been perfuaded,
thereby, to fuppofe that all objects appear yellow to thofe who have the
jaundice, which Hoffmann (x) fays, is call'd into queftion, by our Mer-
curialis in his Praleftiones BoKonie?ifer, by which he meant perhaps to fay in his
Praleftiones Patavina (y), or rather, in his Lefliones varia (z). For in
thefe writings, having brought the teftimonies of Varro, Lucretius, Sextus
Empiricus, Cafflus the phyfician, and even of Galen himfelf, all of which
affirm this circumftance, he put in oppofition thereto the tacit teftimony of
other medical writers, who are filent upon the fubject, and his own repug-
nant obfervation, in a great number of icteric patients. And he might have
join'd with his own obfervation, a great number of others, without doubt-
ing but he would have of thofe who fhould fucceed, by much the greateft.
part, affenting to his doctrine.
At lead, even lately, although after Sydenham (a), Boerhaave alfo (b),
had written the fame as thofe ancients, that very learned man, Haller (c), has
confefs'd " that he did not find evident experiments to prove this obfervation,"
nor had he read, " that the cornea had been found yellow," in icteric bo-
dies •, and that not only a flight change of colour, in the humours of the
eye, but a very great one, was requir'd, in order to produce this effect : as,
for inftance, when from blood being extravafated into the aqueous humour,
according to the obfervation of St. Yves, the light appear'd to be red. And,
indeed, Boerhaave feems to me, when he aliened this a fecond time {d), and
produe'd another obfervation of his own very much fimilar to that of St.
Yves, to have thought " that a little bile mixing itfelf with the aqueous
" humour," might be compar'd with blood being extravafated therein. But
it probably happens, from the extreme, fmallnefs of the veffels, going to the
humours of the eye, as has alfo been faid of the internal part of the cere-
brum (/), that a tincture of the bile does not often reach thereto.
(u) Tract, decordec. 2. (6) Prjeleft. adinftit. §. 544.
(x) §. 4. modo cit. (c) Adnot. ad eum locum.
{y) L. i.e. 32. (J) Pr<eleft. modo cit. §. 8.) :•.
(b) L. 6.0 12. {e) N. 7.
(a) Procefs in morb. curand. ubi de ittero.
Vol. II. F f To
2i 8 Book III. Of Difeafes of the Belly.
To me, at lead, when I formerly diffected the eyes of an icteric woman,
no appearance of yellownefs appear'd in any of the three humours : nor yet
in the tunica cornea : which coat in this body, as in other icterical bodies,
and particularly in that potter alfo, of whom I fpoke above (f), though I
examin'd it accurately, and, at the fame time, when there was a great yel-
lowneis in the neighbouring tunica adnata, I could never find to have any
yellownefs in it. Yet it may fometimes happen, though very rarely, that
objects appear yellow in this difeafe, that is to fay, if the tunica cornea be
univerfally faturated with bile, and not " then only, which even Mercuria-
" lis grants, but alfo if the humours of the eyes are, at any time, ting'd
with a very great yellownefs-," one or the other of which, or, if you
pleafe, both, you may fuppofe to have taken place, in the two examples,
that Hoffmann (g) testifies his having feen, in favour of the opinion of the
ancients ; and in a third, in like manner (for I do not remember to have
read any more) which is added by the celebrated Scardona (h).
9. And there may be in the eyes of fome perfons either a greater num-
ber, or a greater diameter, of the fmall vefTels going to the tunica cornea,
and to the humours, and, at the fame time, in the blood of thefe perfons,
a matter of the bile which is more fit to pervade and tinge thefe fmall vefiels,
whether this depends upon the nature, and properties of that matter, or on
its quantity. For we fee after it is fecreted, and depofited in its veficle, that
it paffes more eafily through the membranes of this refervoir in fome bodies
than in others, and, in like manner, that it tinges the contiguous parts in
fome bodies with a very deep and faturated colour, and in others with a very
flight one, or with none at all.
That is to fay, the blood, from whence it proceeds, if you choofe to
exprefs yourfelf in the words of Willis, which you fee produe'd here in the
Sepulchretum (/), " is too much inclin'd to a fulphureo-faline dyferafia," in
" fome, and in other has " the fulphur too much deprefs'd :" for which rea-
fon alfo, as the former are very prone to the jaundice, fo the latter, fays
he, " are perfectly free from this difeafe," as he faw in many cachectic and
phlegmatic habits, although " labouring under an obftruction, and \ndu-
" ration of the liver, in refpect to mod of its ducts." Which hypothefes,
however, we muft admit with caution, or wait to diflinguifh the times, and
the changes, which the jaundice itfelf brings on, left you fhould be after-
wards furpriz'd, when you read, in the fame place, the obfervations of
Hildanus (£), or de Graaf (I). For the former aflerts " that a pituitous
" and cacochymic patient had, at times, labour'd under the jaundice
" for fome years together ;" and de Graaf, that the bile of an icteric body
was " entirely ferous, and ting'd with fo flight a yellownefs, that the linen
** rags, which were dip'd into it, receiv'd fcarcely any yellow colour there -
" from."
But in regard to the quantity of that matter, the nature of which I have
fpoken of, it is furprizing how great an abundance thereof may be in fome
(f) N. 6. (/') Schol. ad obf. 1.
(g) §. 4. cit. (i) Obf. 8. §. 13.
(/>) Aphor. decognofc. & cur. morb. 1. 3. c. (/) Obf. 10.
10. comm. ad n. 8.
bodies,
Letter XXXVII. Article 10. 219
bodies, if to that which the native conftitution of the body, the time of
the year, foods, anil di inks, and other things of that kind, which happen to
agree in one effect, have accumulated, another be moreover added ; as, for
inftance, if a fever, if immoderate excrcile in the fun, if poilbn, even that
which is in trod ue'd into the blood by the bite of a venomous animal, and,
finally, if any thing elle of that kind, iliddenly let loofe thofe particles of
fulphur alio, which had been more conftricted, and deprefs'd, in the blood,
and cany them away to the liver, fo that there are, now, more bilious par-
ticles, than it is poffible for this organ to fecrete.
There is, befides, another method ftill more known, by which the matter
of the bile may be increas'd in the blood ; as, for inftance, when little, or
none of that matter, which is in the blood, is feparated therefrom, either on
account of fome diforder of the blood itfelf, or of the internal fecreting organ,
or on account of the pafTage of many branches of the hepatic du<5t, or of the
trunk itfelf, or of the ductus communis being obftructed. For this being
obftructed, although what is already fecreted does not return into the blood,
as many go on to think, yet frefh bile cannot be fent into the full and dif-
tended ducts ; and, therefore, as the matter of the bile is not carried away from
the blood, in the lame proportion as it is increas'd therein, by the concocted
aliments, it muft, of courfe, be augmented more and more every day, and
abound,
10. And in this way that I have fpoken of, it may be obftructed by more
rare or more frequent caufes. In the number of the more rare are thofe
which you read here in the Sepulchretum -, as, for inftance, the ductus com-
munis redue'd to the narrownefs of a capillary veflel (m), or contracted into
ixfelf, like a folid chord («), and indurated (o)y or altogether folid and bony (p)y
or comprefs'd by fome glands which lie round about it (q). And to the more
frequent caufes, in the rirft place belong convulfions, and the crifpatures ari-
fing from hence, which are propagated quite to the beginnings of the fmall
branches of the hepatic duct, conftringing and fhutting them up, as they
are the narroweft. And though this effect thereof cannot, from the very na-
ture of the caufe, fall under the notice of the fenfes, yet it is fo confentaneous
to reafon, that we may, without any fcruple, make ufe of this hypothecs, to
explain thofe jaundices, which have their origin, either from violent affections
of the mind, or from pains.
There are, alfo, very learned men, who thus explain the jaundice that is
brought on by the bite of the viper, from whom I fhould not diffent, if the
inteftinal feces are but white at that time, as the ftrong conftriction.of the
orifice of the ductus communis, from convulfion, which they fuppofe, re-
quires: but if they continue to be yellow, and even yellower than ufual, I
fhall then go on to underftand and explain the cafe, in the fame manner that
I juft now told you (r), before any obftruction of the paflages was fpo-
ken of.
Moreover, among the more frequent caufes, are to be number'd the ob-
ftructions happening in the other vefTels, as well as in the biliary veffels,
(«) Obf. 14. {p) Obf. 16.
(») Obf. 17. (f) Obf. 11.
(0) Obf. 25. §. 7. (r) N. 9.
F f 2 though
220 Book III. Of Difeafes of the Belly.
though it is my intention, chiefly, to confider the latter in this place, whe-
ther the obftrucYion of thefe tubes is made by fome particles being fecreted
with the bile, which are grofler and more vifcid than they ought to be ; or
is owing to calculi generated from thefe, and from the bile, by which the
branches of the hepatic duct, or the trunk itfelf, or the dudlus communis,
are ftuff'd up. And I do not fay, the cyftic duel:, for this reafon, becaufe
the obllruclion of this paflage is not able, of itfelf, to impede the pafTage of
the bile from the liver to the inteftines •, although there have been many in
former times, and are fome even in ours, who, in fpite of the admonition of
Wepfer (j), " that a jaundice did not follow the obftruction of the neck of
44 the gall-bladder, unlefs the dudlus communis, alfo, is obftrudled," have
thcmfelves fuppos'd that men became jaundie'd, not only from a calculus
flicking in the cyftic duel:, but alfo from a calculus in the cyft.
In regard to which opinion, that you may plainly perceive what is to be
thought thereof, whatever remains of this letter (and a great part of it does
remain) will turn upon the confederation of bilious calculi ; fince thofe things
which I have hitherto hinted at may be fufficient for you to attain to moll
of the other caufes of the morbus regius, and, at the fame time, to open a
way to thofe things which remain to be faid on the fubjec~l of bilious calculi,
either when within, or on the outfide of, the liver.
1 1. Thefe calculi are generated in the liver, " very frequently," and found
in difieftions, according to what Platerus afTerts in the Sepulchretum (t), and
Henenius (u),. who fays they are " often fo large as would fcarcely be cre-
" dible." To both of whom I will not deny but it might have happen'd
fo. But as to what Matthiolus has fuppos'd, in dependance upon certain
reafons (#), that ftones are generated " in the liver very frequently, as they
44 are in the kidnies," I confefs if I attend to the almoft innumerable de-
fections of the human liver, made by Valfalva, and by me, I cannot readily
aflent to his opinion. For although both of us have found calculi in ma-
ny kidnies, it never happen'd to me to find more than one in the liver
formerly : and Valfalva never found one, in all his difiections, that I know of.
But when I fay thefe things, I mean no more than to confider that com-
parifon betwixt the calculi of the kidnies, and the liver, as I am by no means
ignorant, even from the Sepulchretum itfelf, by how many eminent men they
have been found, or taken notice of, in the liver. For befides thofe three
whom I have mention'd, I fee that the names of our Fallopius()05 Scaligerus (z),
Trincavellius (a), Dodonseus (/>), Camenicenus (c), Peucerus (d), Blafius (e).
Hcerius (f), Dobrzenfkyus (g), for fo his name ought to be written, are pro-
due'd : to which I could add others, and among thefe Columbus (b), Fo-
reftus(i), and Reverhorflius (k) : none of whom, however, has fuppos'd ob-
{s) In additam. ad hanc 18. Sepulchr. feet, (c) Ibid. obf. 8. %. 12.
obf. 4. {d) Cit. obf. 13. §. 3 k 8.
(/) Seft. 17. 1. hujus3. fchol.ad §. 1. obf. 13. (e) 9-
(u) Obf. cit. §. 2. (f) 10.
\ie) Seft. hac 18. fchol. ad §. 12. obf. 8. (g) Seel. 16. obf. 5.
(y) Obf. 13. cit. §. 6. \b) De re anat. 1. ult.
(z) $. 4. (;') L. 19. obf. med. 14.
fa J §. 7. (£) Diflcxt. de mot. bilis §. 52.
(i>) Se&. 18. cit. obf. 4.
fervations
Letter XXXVII. Article 12. 221
fervations of this kind to be frequent. If you examine each of thefe au-
thors ieparately, you will, perhaps, be furpnz'd, that except Dodonreus,
Camenicenus, and Dobrzenikyus, there is not one who makes mention of the
jaundice in thefe patients, or even defcribes the duclus communis as (hut up
with a calculus, or the liver full of lmall ftones.
But you will ceale to wonder, when you attend to this circumftance, that it
is not fufficient, in order "to fhut up all the paflage of the bile, that a few
and lmall calculi have been form'd in the liver, nor even that large calculi
have been form'd there, unlefs they are lodg'd in fuch a part as to befet the
larger branches of the hepatic duct, and entirely (hut them up, either by
comprefiing or obftructing them, which may be alio brought about by fmall
and innumerable calculi, " filling" the whole liver "on every fide," as Do-
donxus lays, not lying at a diftance from each other, " in a fcatter'd way,"
as was feen by Foreftus ; for when they adhere in all the fmaller branches of
this duel:, they produce the fame efte£t as if they ftop'd up the trunk itfelf.
12. But I have faid that the paffage of the bile is prevented from calculi,
either by means of compreffion, or obftruction. For if any one fliould fay
that calculi are fometimes form'd in the little glandular bodies of the liver
themfelves, and that to this clafs, without doubt, belong'd thofe lefifer cal-
culi, which Riedlinus (/) faw " on the external furface of the liver," I (hould
not conteft his opinion, although I believe they are more frequently generat-
ed in the very branches of the hepatic duel:, as thofe who have very mi-
nutely trae'd them, have found. And as, certainly, nothing had happen'd
more frequently to Ruyfch (w), in oxen and fheep, than to find calculi in
the pori biliarii, fo nothing happen'd " more rarely," than to find thefe con-
cretions in the " parenchymatous fubftance of the liver itfelf-," fo that, al-
though he very attentively " diffected away all the flefhy part," in more than
a hundred livers, yet he found in one only, a calculus " buried in the paren-
" chymatous fubftance, and not at ail afHx'd to the porus biliarius."
Nor can I fuppofe, that the ancient obfervations of Platerus (»), of hepatic
calculi refembling " a tophaceous concretion, ramified in the manner of coral,
44 and hollow internally," are to be refer'd to any other part, than to the
fame biliary branches, efpecially as I read GlifTon (o) exprefsly aflerting, that
fimilar obfervations " of tubuli of fo great a length, that if they could
° but have been taken out in their perfect ftate, they would, like coral,
*' have refembled a great number of the ramifications of the porus biliarius,
" in one continu'd ftony feries," were made by him on the livers of oxen,
and even within the fame pore or duel:. The branches of which Reverhorft,
alio (p), found to be internally befet with a calculous cruft, in the body of
a man.
Nor have I found calculi, in the human liver, in any other place than
in thefe branches (q). Nor do I fuppofe that thofe ftones, which by Co-
lumbus (r), and Camenicenus (i), were fuppos'd to be found in the vena
(.') Eph. n. c. cent. 3. obf. 45. (/>) §. 52. cit. fupra ad n. 11.
(/■;) Obf. edit, cum dilucid. valvular, ia (qj Epiit. anat. I. a. 43.
lymphat. 24. (,-)
(n) Schol. cit. ad obf. 13. \f) Locis cit. ad n. 11.
(0) Anat. hep. c. 7V
p<3rtarum,
222 Book III. Of Difeafes of the Belly.
portarum, had any different fituation : yet my reafons for thinking thus, al-
though not fufficiently attended to by ibme authors of eminence, as I have
already given them on a former occafion (/), I fhall not repeat here. Thefe
calculi, therefore, when at length from tubular bodies, by continual and
frefh accretions of fimilar matter, they are made perfectly folid, as happens in
aquasdutts, muft, without any doubt whatever, occupy the whole paflages
whereof I have fpoken, and prevent the tranfit of the bile.
13. I have alio faid this ; that calculi of the liver, though large, do not
bring on a jaundice, is not to be wonder'd at, unlefs they are in fuch fixa-
tions as necefiarily to obftruct thefe paflages. And I believe that this difeafe-
was prefent, for I cannot now pofitively affirm it, in a certain man, whole
liver had a ftone in the center of the concave furface, of the form and mag-
nitude of a pigeon's egg, as an anatomical friend of mine, who had dil-
fected the body, inform'd me by letter, many years ago. But I do not won-
der that this diforder had not been obferv'd in three women, who, although
they had a much larger ftone, or a greater number of concretions, and more
heavy ones, within the membrane of the liver, neverthelefs, had them in
fuch a fituation, that they feem'd to be rather on the outfide of the liver, than
within its fubftance : and this was the reafon I did not make mention of them
above. For that membrane being drawn away from this viicus, by the in-
cluded weight, and being extended downwards, had form'd a facculus in two
of them of the length of a fpan ; for in the third it was defcrib'd only as a
follicle, pendulous downwards.
This laft oblervation is from Benivenius («), and is totally different, as you
will eafily perceive by comparing them, from the fecond, which is given in
the Sepulchretum (x)t from the third chapter of his book. And a fimilar
oblervation to his; except that in the facculus not many calculi were con-
tain'd, but one large calculus, only, was included, together with a great
quantity of glutinous humour, and that the woman never complain'd of any
thing but of a heat in her liver ; the obfervation of Georgius Greifelius (y)>
is fubjoin'd. And it was in confequence of bearing' thefe examples in my
mind, and obferving therefrom, that befides the gall-bladder itlelf being en-
larg'd, another kind of cyft, diftended likewiie with a fluid, might fometimes
hang. below the liver, which, although it was entirely preternatural, would,
neverthelefs refemble this natural cyil; it was in confequence, I lay, ofrea-
foning from thefe examples, that in the cafe of Laurence Bacchetti, formerly
a phyfician at Padua, rhe hiltory of whole diieafe, and diffecYion, two other
learned men have publifiYd, fince Dominic Militia (a), I carried myfelf with
fo much caution, as not to affirm any thing for certain, though I made no
fcruple to declare my opinion.
This gentleman had a tumour hanging below the liver, which you imme-
diately felt by applying your hand to the abdomen : it was globular, and
moveable, fo that you could eafily bring it towards the right fide, or
towards the left, by means of the hand with which you laid hold of it.
When different phyficians feem'd to have different opinions, as you will read
(t) Epift. 1. cit. n. 49.
(«) De abdit. nonnull. &c. c. 94.
(*) Seft. 17. cbf. 13. \. 1.
(y) Ibid. §. II.
(a) De niorb. exitial. nob. virgin.
in
Letter XXXVII. A; tide 13. 223
in Militia, who declares the feveral opinions of all ; to me, who faw him. once
after others, this tumour feem'd to be the gall-bladder, enlarg'd by an im-
moderate diftenfion of fluid, and produe'd downwards, which I declai'd to
Dominic Stephanelli, a phyfician, and friend of the patient, who with great
politcnefs attended me home, and very earneilly deiir'd my opinion ; yet I
made this declaration in fuch a manner, as to affirm nothing for certain. What
I had thus declar'd was fo evidently confirm'd by the difteclion, that al-
though the declaration might be pals'd over by fome, yet the appearance itr
felf could be conceal'd by no body.
I had feen the fame thing before, and particularly in an old man, from
whom I had already defcrib'd it, in the firft of the Epiftohe Anatomies (b).
And I remember'd to have read of it very frequently, and not only among
the ancients, as when Vefatius (c) found, in Martellus, the fame cyft, "of the
" bignefs of two fills," or when Fernelius (d) faid that it is fometimes diftended
by exuberant bile, " into a very large fize •" but among the more modern au-
thors alfo, as, for inftance, in Zwingerus (e), who faw it " about fix times
" larger than is natural," but particularly the younger du Verney (f) and Yun-
gius, whole obfervation of one of a ftill more monftrous fize, is taken notice of
by Abraham Vaterus (g) ; fo that after this I do not think it worth while to
point out thofe which have been fince produe'd, nor yet to inquire how great a
cy(l was found by Lancifi, which, by reafon of its very remarkable length,.
Pacchioni intended to defcribe, as he exprefies himfelf in a letter which he
wrote to me in the year 1710. Although two obfervations, which I lately
read in the writings of the very illuftrious Van Swieten (b), are by no means
to be neglected : the firll from thofe of the illuftrious fociety at Edinburg,
who found this cyit to contain eight pounds of bile, and that in a boy not
more than twelve years of age ; the fecond made by himfelf, who, in the
body of a woman, found the fame cyft to be fo diftended, as to reach quite to
the right os ilium, and this cyft had protuberated, by its own bulk, betwixt
this bone, and the lower ribs, even before her very lean carcafe was cut
into.
But it was alfo found to be extended, in a Polonian fenator (/'), " to fo
" furprizing a degree," that in the living body, " it could be felt by the
" hands." To return, however, to thofe things which were publifli'd at
that time, which was in the year 1732, although I very well remember'd
them, yet not unmindful of thofe three obfervations, that I pointed out in
the firft place, of a facculus hanging down from the liver, nor yet of the ad-
monition, in the latter end of the fixth book de morbis popularibus, that even
good phyficians, " not to mention others," are often deceiv'd by " appear-
" ances," I was not willing to imitate Baglivi, who, if he were living at pre-
fent, and fhould read what is written by our Vallifneri (k), and Scheffe-
lius (I), would certainly repent of having written too haftily, and in confe-
(i) N. 43. (b) Comment, in Boerhaav. aph. §. 950. &
(<■) Epift. de rad. chin. 935.
(d) Pathol. 1. 6. c. 5. (/) Commerc. litter, a. 1733. hebd. u. n. z.
(<?) Acl. n. c. torn. 1. obf. 78. (/£) Opere t. 3. p. 6. lett. 37. annot. 1.
(f) Mem. dePacad. r. des fc. 1701. (/) Diffcrt. de lichiafi fell. §. 28.
(g) Diflert. qua calculi in vaiic. fell. &c.
thef. 5.
quence
224 Book III. Of Difeafes of the Belly.
quence of attending to fome obfervations, but not to all that it was in his
power to attend to (tn)> " when you fee obftinate jaundices, or thofe that
" have been cur'd, return afrelh, you may take it for granted, that thefe
" are produe'd by a calculus of the gall-bladder, and for this reafon you may
" pronounce them incurable."
14. But in order to treat of thefe calculi of the gall-bladder, according to
my promife, inafmuch as their fituation certainly is on the outfide of the li-
ver, let me firft obferve, that there is fo great a number of obfervations, of
thefe concretions being found in the human body, that the lift of thofe which
relate to the calculi of the liver, admits no idea of comparifon therewith.
And if you inquire after the reafon of this difference, you will find more than
one, when you attend to the caufes which are advane'd, for the generation
of calculi in the cyft being fo frequent.
Our Veflingius (») has fuppos'd the thicknefs of the cyftic bile, and its ve-
ry long fbagnation in that cavity, by which the meatus cyftici, and valvulse,
are much ftreighten'd, and lefs paffable. And thefe caufes you will find fo pe-
culiar to the cyft, that the greater part of them are not, by any means,
transferable to the hepatic ducts, and it is fuprizing that a very eminent phy-
fician, among the more modern, who has acknowledg'd thefe very caufes of
the difference we are fpeaking of, has not equally obferv'd that they are alfo
common to the cow fpecies •, in which, as he there confefles, that hepatic calculi
are more frequent, fo he ought, at the fame time, to have affign'd fome caufe
of this difference betwixt the human fpecies, and this fpecies of animals.
But thofe things, which Veflingius had previoufly demonftrated, were, in
the mean while, illuftrated, and enlarg'd, by others ; either by remarking a
greater thicknefs of the bile in fome men, and a greater difpofition to concre-
tion •, or by acknowledging a longer retention than is natural, by reafon of
the fpafmodic crifpatures, and conftrictions of the cyftic duct ; or by reafon
of the power of felf-contraction being deprav'd, and weaken'd, in the re-
lax'd coats of the veficle. And this weaknefs of the coats becomes fo much
the greater afterwards, in proportion as a greater quantity of bile is retain'd,
juft as it happens in the urinary bladder, when from the quantity of retain'd
urine its power of contraction is weaken'd, and overcome : which is a fimile
that was not only us'd formerly by Galen (<?), but has even been us'd by the
younger du Verney (p) in the prefent age : and from hence you underftand
what is, in general, the principal caufe of thofe vaft enlargements of the cyft
being brought on, which I fpoke of juft now.
To thefe caufes others were, moreover, added by Abraham Vater (q),
whofe name ought not to have been fupprefs'd by thofe who wrote the fame
things afterwards. For he, having remark'd how difficult it is for the bile to
afcend, on account of the declivity of the fund of the cyft, and obferv'd the
neceffarily flow paffage thereof, on account of the obliquity of the duct,
judg'd, from confidering both thefe caufes, that the cyft being comprefs'd by
the ftomach, none but the thinneft, and moll fluid, part of the bile was
fqueez'd out, and that the thickeft was always left behind, in healthy bodies,
(m) De experim. circa bilem. (/>) Cit. fupra ad n. 13.
\n) Synt. anat. c. 4. (7) Obf. rariff. calcul. 3. §. 1.
(0) Deloc. aff. f. 5.C.7. haud itaproculafine.
which
Letter XXXVII. Article 15. 225
which would eafily concrete, unlets it was prefently diluted by a new aftlux
of hepatic bile, and reftor'd to its former confillence.
But when this frefh afflux is either lefs than it ought to be, or the bile is
fecreted in a more vilcid ftate than ufual, it does not fully anfwer the pur-
pofes of dilution, and renovation-, for which rcafon the infpiflated bile of the
cyft more eafily degenerates into calculi. And Fernelius (r) had trae'd out thefe
caules to Vaterius, and, infome meafure, even to Veflingius, when he aflert-
ed that thefe calculi " had their origin from yellow bile, which having been
11 long retain'd in its proper receptacle, and not timely evacuted, nor dilu-
" ted, and renovated, by a new influx, grows hard in a furprizing man-
" ner."
15. Since, therefore, in this great infirmity, and intemperance, of human ,
life, fo many caufes, which mult be readily granted, are at hand to favour
the production of cyftic calculi, there is not the leaft reafon to wonder that
they have been fo often found, both by the ancients, and by moderns. For
after Gentilis (j), and Nicolus (/), had teftified their having feen concretions
of this kind, the latter in the gall-bladder, and the former in the meatus
thereof, Benivenius (u), Vefalius (*), Curtius (jy), Falloppius (z), Fernelius (*),
Stephanus (#), Columbus (£), and Coiterus(c), to take no notice of authors
of lefs note, produe'd their obfervations to the fame effect : and from the
time that human bodies began to be more frequently difiected, even to this
very day, no writer in anatomical, or medical, matters has had occafion to
fpeak pretty fully of that veficle, but he has made mention of calculi being
feen by him there •, fo that it is with juftice the celebrated profeflbr Fabri-
cius {d) fays, that calculi of the gall-bladder have, in general, been more
frequently obferv'd than thofe of the urinary bladder •, and it is mown by the
illuttrious Haller ((?), that they are even to be met with more frequently in
fbme countries.
"Wherefore I would not have you be furpriz'd, if I fay, that while I write
this prefent letter, I have before my eyes, at leaft two hundred obrervations
of this kind, nineteen of which are my own •, but I would rather have you
wonder that I have not read, or do not remember, a great many more. Yet
thofe, of which I have fpoken, are not fo few in number, but that I may
from them venture to anfwer your inquiry, as to what occurs more frequent-
ly, or more rarely, in cyftic calculi, and that without feeming to anfwer too
haftily, or rafhly. You may make this inquiry firft of all, in what kind of
bodies they are mod frequently found ? For Carolus Stephanus (f) has af-
ferted, that they have been feen by him, " chiefly, in women, who were
" pretty far advane'd in life :" and, in this age, Frederick Hoffmann (g) has
faid, " that they are found very rarely in men, who are in the flourifhing time
(>-) C. cit. ad n. 13. (*) Cit. ad n. 14.
(■») («) Dediflect. part. corp. hum. 1. 3. c. 42,
(t) Apud Donat. de med. hift. mirab. I. 4. \b) De re anat. 1. ult.
c 30. (c) Obf. anat.
(") {/) Propempt. ad diflert. Jo. Barth. Hoft-
(x) Cit. fupraadn. 13. mann.
( <•) Comment, in mundin. anat. ubi de he- (e) Opufc. pathol. obf. 33.
pate in fin. (f) C. 42. modo cit.
(z) Obf. anat. (g) Med. rat. t. 4. n. 2. f. 2. c. 3. §. 12.
Vol. II. G g "of
226 Book III. Of Difeafes of the Jklly.
" of life, but more frequently in old men, and ftill more frequently in women?
" than in men." The firft thing pronounc'd by Hoffmann, therefore, is
much more true than the laft. For I fee in the observations fpoken of, that
the number of males and females is nearly equal. But although I find old
people, promifcuoufly, of both fexes, to the number of fixty-one, whole ao-cs
are particularly pointed out by the obfervators, I find no more than eight
who are faid to be young : and among thefe there is no infant, and but one
child •, and the lcafi age, amongft thefe eight, is that of twelve years, and
the greateft nine and twenty.
"Without doubt, in a fiourifhing time of life the juices are thinner, more
brifkly agitated, and lefs prone to concretion, than in the decline of life, or
as Hoffmann particularly faw, than in the lefs laborious life of very old men,
efpecially, and women. For which reaibn Haller, whom I have already com-
mended, accounts for " the frequent calculi of the gall-bladder, which he
*' found in criminals, who had been long confin'd to prifon," from the want
of mufcular action (h). And to the fame caufe, you muft refer what the il-
luftrious Van Swieten (i) found to happen in bile, which was not agitated.
For, " having left it to putrify in a pure glafs veffel, he found calculous
" coagula in the bottom of the veffel. " Yet the middle age, although it is
an active feafon of life, has not juices to be compar'd with the fiourifhing
prime of our age, for which reafon it happens, that this time of life cannot
equally refift the injuries of intemperance, and of the paffions,to both of which
it is ftill more liable than old age. If you add to this, that a great part of
the women in the lower clafTes of the people, do not lead a very fedentary
life : and if you compare all thefe things with thofe which are faid above (k)>
upon the caufes that produce calculi of the gall-bladder-, you will, of courfe,
eafily perceive that the obfervations are confonant to reafon.
1 6. But if you now inquire, whether Reverhcrft (/) has written truly or
not, when he has admonifh'd us, that we might remark, in regard to thefe
calculi, " that the younger the body is from whence they are taken, the
" more pale are they in their colour, that in a middle age they are of a yel-
" low colour, but in a more advanced time of life of a darker yellow, or even
*' almofi black," it will be much more eafy to give you an anfwer to this
queftion. For it is not the queftion, here, what is more frequent, but what
is perpetual ; fo that I can readily affirm, even from infpe&ing my own ob-
fervations, that this is too haftily pronounc'd. For I have found not only
blackifh, but very black calculi, in many of a middle age likewife ; in a young
man of five and twenty, and in an old woman of feventy-five (the former of
which is the youngeft, and the latter the oldeft, from whofe gall-bladder I
have hitherto taken calculi) they were not very different in colour from each
other, fo that they were neither black in the old woman, nor very pale in the
young man, efpecially if you compare them with one of a cineritious colour,
which I found in a woman of fixty years of age within one.
But that you may not depend upon my obfervations alone, I have, cer-
tainly, not read of calculi being found in a younger woman, than that virgin
(b) Experim. anat. de fang. mot. c. 6. (A) N. 14.
(/) Comment, in Boerhaav. aph. §. 950. (I) Diflert. de motu bilis §. 57.
of
Letter XXXVIT. Article rj. 227
of nineteen, who is ddcrib'd by BonetUS, in the former book (w). Yet in
her all the Hones were " yellow, aWd fed bile in their colour." On
the contrary, that woman, irratcly d'efcrib'd by Cajetanus
Tacconus («), was of an advane'd age, that is of (ixty-thrce years, and af-
d with a black jaundice befides. Nevcrthelels, all the c; om her
\\ " not only inclin'd to a whitilh colour, or dilute faffron hue ;" but,
notwithlbnding they v.ere- internally yellow, were furnifh'd with coats that
were " white, and mining, and refemblcd the internal filver furface of mo-
" ther of pearl."
And, without doubt, the age is not to be fo much confider'd, as the mat-
ter of which they are, or have been, made, for they do not always bear the
colour of the bile in which they are found ; and this colour, according to the
Various difpofition of the blood, or of the organs, may fometimes be, or
have been, of a different nature, or the bile may have even hid, under the
lame colour, particles of a different kind, though at the fame time of life, and
equally proper to form calculous concretions. Thus Abraham Vater (o), thus
the celebrated Trew (p), to pais over other obfervations of my own, and thofe
of different authors, met with them in the manner I am fpeaking of; for the
former " found a calculus, jn a very thick and black bile, which was of a co-
" lour inclining to white," and the latter, in bile which was of a bright yel-
low, found a calculus that was, externally, '* in great meafure white, and
** brown in other parts, but became very white, by means even of the
" flighted friction," yet internally, if you excepted " a kind of redifh fpot,
*' it was pale," and the former of thefe appearances was in a man, and the
latter in an old man, not in any young man.
1 j. Nor do they more favour the opinion of Reverhorft, who have, in
general, affirm'd that thefe calculi " are found to be black, blackifh, or
" brown, for the moft part :" although, as I know that the calculi found by
our ancellors, and by others, have been frequently of a colour of this kind, fo
myfelf alfo confefs, that I have more frequently found them in the former
years of my obfervations, than in the latter •, yet a great number of mine, and
Hill a greater number of the obfervations of others, mult of courfe flip my
memory, before I can eafily believe that thefe concretions are " for the molt
" part " found to be of that colour. Kentmann, as you read in Schenck (q),
writing of thefe calculi in general, fays that they are " all of a colour ap-
" proaching to yellow, which is, by degrees, chang'd into a deep yellow, or
" faflron colour, as they increafe in their fize," and indeed he foon after pro-
duces examples " of a kind of yellowifh calculi," and " of a yellow one" be-
ing found here by our Falloppius.
But a much greater number of inftances are added, in the writings of the
fame Schenck, of concretions of a different colour. And this mult be grant-
ed : but then other obfervations are to be fet in oppofuion thereto, as of Jo-
annes Francus (r), who law calculi " of a faffron colour," as of Casfalpi-
(m) Sepulch. I. 2. f. 4. obf. 35. (7) Obf. med. 1. 3. ubi de Vefic. fell, lapid.
00 De rarisquibufd. hepat. affect, obferv. obf. 1.
(0) Diflert. c]ua calculi, Sec. thef. 4 & 5. (r) Ibid.
(j>) Commerc. litter, a. 1743. hebd. 32.11.
3. & hebd. 36. n.4.
G g 2 mis,
v
228 Book III. Of Difeafes of the Belly.
nus (j), who faw them of the fame colour, as of Bofchus (t), who found
them " of a citron colour," as of Panarolus (u), and Dobrzenfky (*), who
found them " of a yellow colour." Nor indeed are Hoechftetter (y), Schel-
hammer (z), Steinius (a), and Bierlingius (£), to be pafs'd over, by whom
" yellow, yellowim, and faffron colour'd calculi" have been feen ; nor yet
Horftius (c), nor Helwigius, (V), by both of whom a great number was
found-, thole being all of a " yellowim colour" which were feen by the lat-
ter, and, in part, by the former.
To thefe you may add Platner (e), and Bezoldus (/), one of whom found
them " of a golden yellow colour," and the other " of a yellow colour in-
'* dining to white," and not only thefe but even many more, among whom
are the members of the laudable fociety at Edinburgh (g), who found
" yellowim calculi," in a boy of twelve years of age, and the celebrated
Trew (£), who faw them " (lightly yellow externally," even in the body of
a perfon who had liv'd more than feventy-four years, and ftill more the ce-
lebrated Haller (i), as he faw, even in a woman who was faid to be more
than a hundred years of age, perhaps all the calculi, but, at leaft, one of
them in particular, of a yellow colour." The fame author having found
fixteen in another old woman (£), fays that thirteen of them were " yellow :"
and that in a man who had been hang'd (/), they were of a yellow colour
" inclining to white." But Weitbrecht [m) even found them to be " yellow,"
in an old man.
Other obfervations, befides thefe, I have either jufl now taken notice of, or
mail take notice of hereafter : and ftill others, and thofe not few in number, I
mall purpofely pafs over ; for it is not my intention to point out them all, but
only as many as are fufficient to fhow, that thefe gall-ftones are not found,
" for the moft part," of a black or brown colour. And evenVater (»), Hoff-
mann (o), and Bezoldus (p), when they treated of the colours of thefe cal-
culi, in general, put among the number of thofe, which are " commonly,"
or " more frequently," obferv'd, " the concretions of a yellowim hue," as is
the expreflion of the two firft ; and Bezoldus has particularly faid " that they
'' moft frequently incline to yellownefs."
1 8. And although a great number of thofe who have mention'd cyftic
calculi, have been filent in regard to their colour, yet there are fo many
who have not been filent upon this head, that it fufficiently appears they ge-
nerally are found to be either of a yellow, or a black colour. I fay gene-
rally, becaufe blue concretions have alfo been feen, as by Coiterus (q), Ne-
(s) QueA:. med. 1. z. in ipfo fine. (g) Cit. fupraad n. 13.
(/) De facult. anat. left. 2. (£) Commerc. litter, a. 1734. hebd. 6. n. 5.
(k) Jatrol. pent. 5. obf. 22. in fin.
(x) Eph. n. c. a. 1. obf. 129. (/) Opufc. pathol. obf. 33. hift. 4.
(y) Obf. med. dec. 10. caf. 9. [k) Ibid. hid. 1 1.
(z) (I) Ibid. hift. 13.
(a) Apud Scheffel. did", de lit. fell. §. 10. (m) Commerc. litter, a. modo cit. hebd. 9.
(b) Sepulchr. 1. 4. f. 1. in additam. obf. 12. n. 2.
(<-) Ibid. 1. 2. f. 7. obf. 125. («) DifTert. fupra ad n. 13. cit. thef. 3.
\d) Ibid. 1. 3. f. 7. in addit. obf. 1. (0) C. 3. fupra ad n. 15. cit. §. 2.
(c) Progr. edit. 17. mart. a. 1746. (p) Difiert. modo cit. §. 5.
(f) Diflcrt. de cholelitho caf. 1 . (q) Obf. anat.
4 retius
Letter XXXVII. Article 18. 229
retius (r), and Goritzius (s), who alfo obferv'd " fmall red points," per-
haps from the particles of the adhering cyft being lacerated here and there :
for this calculus was fo ftreightly confin'd in the cyft, that there was a ne-
ceifity of extracting it by force : and they have been feen of a red colour,
as by Camenicenus (7), and by Bartholin (u) : of a cincritious, as by our
Fabricius (x) and Bolcus (y) : of a whitifti colour, as by Reverhorft (z), by
Vater (a), by Haller {b) by-Van Swieten (c); and even of a filver colour, as by
Platerus (J) : of a golden colour, as by the lame (e), and in part by others ;
for I have not undertaken to mention every one in this place : and finally,
of a green or greenifli colour, which is much more frequent than thofe laft
fpoken of, or others which for the fake of brevity are omitted, fo that I have
very often feen the fame, the cincritious fometirr.es, the golden-colour in part
now and then, but the others I have never yet feen.
Neverthelefs I have alfo feen calculi of a variegated colour, in the manner
I have defcrib'd them in the epiftle fent to Schrockius (f) ; and Gerbezius
(g) faw them of a brown colour mix'd with white •, Baeumlinus (h) of a
white and yellow, inclining to green •, and many others, that were contain'd
even in the fame cyft, diftinguifh'd with fpots of bright red, or fcarlet
hue, and with others of pale or a grifly colour. Out of which colours, and
others that are juft now mention'd, you cannot properly call any one black.
And to thefe you may, moreover, add the calculi which are without, or al-
moft without, any colour : of which kind was that large one found by Scul-
tctus (/), which not only fill'd the cyft, but even diftended it, and was " pel-
" lucid like chryftal •," or thofe that the royal furgeon Tamponettius (k),
and Manchius (I), formerly found, the latter " tranfparent, though friable,.
" and of the bignefs of a filbert," and the former " miping and foft like a
" concreted gum, and of the bignefs of a pigeon's egg," (fo that it brings
to my mind one defcrib'd by the celebrated Heifter (*»), which, beneath a.
rugous furface, " had a fubftance, and, in general, a colour, not far unlike
'* a gum, which is fomewhat more folid than gum arabic) or that which is
" reprefented, in a plate, by Bezoldus (»), of the form of a chryftal, and
" perfectly pellucid," found by Henricus Albertus Nicolai, and pointed out
in the fifth obfervation (<?).
That whitifh calculus, alio, which I have more than once mention'd from
Vaterus (p), was pellucid and tranfparent:" to which, if you attend lefs to
the colour, you may add from the Sepulchretum (*), thofe thirty found by
[r) Apud Schenck. obf. cit. fupra adn. 17. (/) In aft. n. c. torn. 2. obf. 147.
(s) Eph. n. c. cent. 8. obf. 20. (g) Eph. n. c. cent. 1. obf. 57.
(t) Epiih ad Matthiol. (/>) Commerc. litter, a. 1743. hebd. 28. n. z,
(h) Cent. 3.epift. med. 86. (/) Armata chir. obf. 61.
(x) Apud Schenck. obf. cit. (k) Zodiac, med. gall. a. k April, obf. 7,
(y) De facultat. anat. left. 2. (/) Ibid, maiobf. 8.
(%) §. cit. fupra ad n. 16. (m) Aft. n. c. torn. 1. obf. 181.
(a) Difl". ibid. cit. thef. 4. (n) Differt. de cholelitho §. 5. fig. 4.
(b) Obf. cit. ad n. 17. hiil. 1 & 6. (0) Dec. obf. illuit.
(c) Comment, cit. fupra ad n. 15. §. 935. (p) Thef. 4. hie cit. & 5.
adz. (*) L. j.f. 17. in addic. append, ad obf; 2.
(d) Obf. 1. 3. ubi de tereft. excret. §. L.
(?) Ibid.
Scharpiu*,
230 Book III. Of Difeafes of the Belly.
Scharpius, which were " pellucid like a carbuncle •," and perhaps, likewife,
eighty more, which were found by our Sanctorius (q), " fimilar to the ftones
" call'd chryfolites," I fuppofe like the chryfolites which are defcrib'd by
Pliny (r), " tranfparent, and of a golden colour."
But if you would confider nothing befides a mining property, in cyftic
calculi, others ought to be taken notice of here, as from Grifelius (s) that
which was a little lefs than a hen's egg, and when broken, " fhone as if
" it had been full of nitre ;" or from Jo. Theodore Schenck (7), and Jo.
Rhodius (u), thole which were many degrees lefs than the laft-mention'd,
but being broken, in like manner, fhone like chryftals " of tartar" or talc,
as that alfo did like " talc,*' which I firft took notice of from Trew (x) :
and even to myfelf (y), the nucleus of ibme has appear'd to be diftinguifh'd
here and there, with a kind of fhining points. But that thofe " blue con-
" cretions" of Neretius (z), or Platerus (a), were mining, the former, at
" onetime, of a bright filver colour, and at another time, of a bright golden
" hue," that is externally only ; for I do not read that they were broken ;
has but little reference, I think, to thofe of which I juft now fpoke. To
which I fuppofe, thefe that are defcrib'd by Baglivi (b), may be with more
juftice fuppos'd to relate; for he fays that they " almoft emitted fparkles, as
" if they had been a congeries of black fait chryftalliz'd."
However, to that clafs certainly belong, chiefly, thofe two which were not
long ago defcrib'd by the celebrated Morand (c), one from the obfervation of
the famous Geoftroy, and the other from his own, the former internally in
part, but the latter externally, and internally, for the moft part, fhining,
and almofl quite pellucid : and to that clafs belong other calculi defcrib'd by
other authors, and particularly by the very excellent Haller fi), which I fhall
more properly take notice of below (e), when I fpeak of the ftructure of
gall-ftones, not without that " chryftalline" calculus, if I am able in the
mean time to find it any where in Hildanus.
- 19. For now it is necefTary, previoufly, to touch upon a few things in
regard to the various magnitude, number, figure, and fituation, of thefe
ftones. There was a time then, when one of thefe concretions was not only
found to fill, but alfo to diftend, the cyft, as I faid juft now, and even to
diftend it " very greatly," as you will fee in the Sepulchretum (f). A cal-
culus, has alfo been found equal to the fize of this cyft, of which you will
have more than one inftance, in the fame place (g). At one time it has been
" half as big as an hen's egg," as our Falloppius found it (h); and at another
as big as a pigeon's egg (for I pafs over the intermediate degrees of mag-
nitude in the fecond and third, as I do in the firft and fecond) of which fize
they have been feen by many after Coiterus (j) j and amongft thefe by our
(q) Comment, in I. Fen. I. can. avic. qu. 76. (/>) De experim. circa bilem.
(r) Nat. hilt. I. 37. c. 9. (<-) Mem. dc l'acad. R. des fc. a. 1741.
(s) Vid. in modo cit. feA. 17. obf. 13. § . 1 1. (d) Opufc. pathol. obf. 33.
(1) Vid. ad Sachiii Gammarolog. epilt. (e) N. 23, & 24.
addit. 7. ad c. 1 .;. (f) L. 3. f. 10. in addit. obf. 1.
(u) Cent. 3. ohC med. 45. (g) Ibid. f. 13. obf. 12. §. 7. & f. 18. obf.
(x) Supra n. 16. 8. $. 14.
(y) Obf. cit. 147, (h) Apud Schenck. obf. 1. fit fupraad n. 17.
(x) (/) Obf. anat.
(a) Locls Paulo ante cit.
Valiifneri
Letter XXXVII. Article 19. 231
Vallifneri (.('), in the hit of the Gonzaga family that was duke of Mantua,
-who fuppos'd it to be an he v dileafe, for this reafon, thai Bartolctus
(I) had likewifc found a calculus at the orifice of the cyit, in Ferdinand
Gonzaga, who was alio a Mantuan nobleman : which would not have been
an improbable argument, if this lall duke had defended from Ferdinand,
who, however, left no fons. But they are generally found to be of a much
lefs fize than theft : and indeed are, fometimes, fo very fmall, that Vefalius
(m) compar'd thofe which he found in Martcilus, to " millet feeds."
And as the gall-bladder, in this body, was certainly equal to the fize of
two fills, as I have even laid above («), and fill'd with ltones of that kind,
you may cafily imagine, from hence, how great a number of them is fome-
times met with. They who have actually number'd them after Falloppius (c),
who, with that pretty large one, found " a hundred and twenty-three," have
reckon'd not onfy " three hundred," as Bartoletus (p)y or " three hundred and
" fix," as the brother of Platerus (q), more than which I have even found,
but above " feven hundred," as Mentzelius (r), and even " above a thou-
'• fand," as Grafeccius (s) did formerly -, fo that it is furprizing, that fome,
fpeaking in general of the number of cyftic calculi, fhould have ftop'd at
the number of Joach. Camerarius (/), that is at a hundred and forty-three.
And what will you fay to an inftance, which is already publifn'd by the ce-
lebrated Storchius (u), of an ancient nobleman, in whom " more than two
" thoufand of thefe calculi were reckon'd up " and another, in like man-
ner, by Fafchius (x), who, in the enlarg'd cyft of a certain man, " found
" three thoufand fix hundred and forty-fix granules of concreted bile, which
" he even ufed to fhow as a curiofity." And although fometimes there are
no more than one calculus, as was demonftrated jufl: now, yet it is much
more common to find a greater number.
And as to what relates to the figure, moreover, fome of them, indeed,
are nearly fpherical, fome almoft oval, or of fome other figure, that is not at
all angular, as even the likenefTes, which are made ufe of by obfervators to
defcribe them, demonltrate ; as, for inftance, that of fome fpecies of nut, an
olive, an egg, or other things of a fimilar kind : but they are for the moft
part angular. And thefe fpherical calculi receive their form from the
figure of the veficle itfelf, whether this be natural or contracted, or enlarg'd,
and made more globular, by difeafe, efpecially when they fill it, and that
whether there are no more than one, or more than one, provided they are
as yet fo foft (for even thofe that are pretty large, fometimes (y) preferve the
foftnefs of new cheefe) as to allow of their being all lqueez'd together into a
form of that kind ; as you fee in the Sepulchretum (z), that inftead of bile,
" there was one orbicular ftone, confifting of nine other triangular (tones,
(k) Epift. fupracit. ad. n. 13. adnot. 2. (s) Apud Schenck. in fine obf. 1. modo cit.
(I) Vid. Rhod. cent. 3. obf. med. 2. (/) In eadem 1. obf.
(m) Epift. de rad. chin. («) Commerc. litter, a. 173$ hebd. 59. n. 4.
(n) N. 13. \x) Vid. in obf. 68. torn. 5. act. n. c.
(0) Obf. i. modo cit. apud Schenck. (y) Eorund. t. 3. append, n. viii. append.
(j>) Obf. 2. Rhod. modo cit. 1 . ad obf. jo.
(q) L. 3. cit. fupra ad. n. 17. (z.) L. 3. f. 17. obf. 14. §. 5.
(r) Eph. n. c. dec. 1. a. 9. obf. 181.
" lyin
232 Book III. Of Difeafes of the Belly.
44 lying mutually upon each other, and eafily feparable by the hand." A
fimilar obfervation to which is extant (a), (except that it is much more fur-
prifing, on account of the exactly equal partition of weight, and, for that
realbn, almoft incredible) " of a calculous globe weighing two ounces and
" a half," which, being taken out of a cyft thatcontain'd nothing elfe, " fe-
" parated into fixty letter calculi, obfeurely yellow, and friabie, each of
'* them having five furfaces, and being equal to the weight of one fcruple
" exactly. " But other examples of cyilic calculi are alfo extant, which, re-
fembling a pigeon's egg (b), " feem'd to be made up of lefier calculi," or
were even " compacted," (c) or " compounded, of mere granules (d)."
Shall we then fay that granules of this kind are the firft beginnings of
cyftic calculi ? They are certainly often found in the veficle, for to thofe
which I have here produe'd, you may add many and many other obferva-
tions, of the fame bodies, as in a virgin fpoken of by the younger du Ver-
ney (e), and in a man mention'd by the celebrated Jo. Sebaft. Albrechtus (f)\
as, in the former, the bile was concreted into fo many little grumous cor-
pufcles, and in the latter, was " like granulated fugar, or had the form of
" blanch'd millet feeds:" and not to be too prolix, as in fo many other bodies
(g), in which there being calculi " of a granulated furface," or " full of
" tubercles in the form of a mulberry," the granules feem to have adher'd
to the furface, and been form'd into one fubftance therewith. It is not to be
doubted therefore, but thefe are the beginnings of thofe calculi, which con-
fift of granules of concreted bile. But in the cyft, together with the calculi,
a great quantity of " fandy and mucous matter (b), and a large quantity
" of fand," has been, more than once, found, fo that the fame perfon, to
whom this occur'd, judg'd " that it was to be confider'd, without any
" doubt, as the matrix of the calculi :" and this perfon was Bergenius (i).
Therefore, if the bile be accreted to a grain of fand, as to a nucleus, you
fee that this is to be look'd upon as another beginning of thefe calculi. To
thefe add others, which have been obferv'd by me, at other times, and which
I Ihall take" notice of with more propriety below (k) ; and you will, at once,
conceive that granules of concreted bile, cannot poflibly be the beginning
of every calculus.
But as I have faid that thefe calculi are, for the moft part, angular, perhaps
you will afk, from whence I derive the origin of thefe angles ? If many cal-
culi which are as yet foft, and round, are compacted into one, cither oval, or
fpherical, body, in the manner I have defciib'd, in two inftances juft now
produe'd, fo that from the compreflion of one againlt the other, they ac-
quire thefe new forms, and after that, from any caufe whatever, are fe-
parated, it is very eafy to conceive of the origin of thefe angles. Yet be-
(a) Aft. modo cit. t. 5. obf. 129. fig. 3 & 4. & eph. cent. ; tab. 1. fig. 3. 4. 5
(b) Commerc. litt. a. 174$. hebd. 24. n. 1. Si 6. Sc Haller. obf. cit. hill. 5.
(c) Eph. n. c. cent. 8. obf. 20. (b) Commerc. litt. a. 1733. hebd, 45. poll.
{d) Haller. opufc. pathol. obf. 33. hill. 13. n. 6.
(e) Cit. fupra ad n. 13. (;) Eta. 1739. hebd. 39' n- '•
(f) Aft. n c. torn. 4. obf. 49. (') N. 22.
(g) Eorund. aft. t. 1. obf. 20. cum tab. 3.
caufe
Letter XXXVII. Article 20. 233
caufe examples of this kind very rarely occur, we generally account for thefe
angles, from the friction of the round calculi, againit each other.
For who can deny the exiftence of this friction, that obferves the fmooth-
nels of their furfaces, or who looks upon thofe two cyftic calculi, which arc
delineated in the works of Hildanus (I) ? For one of them " is Co greatly
" hollow'd out, that it can admit almolt a third part of the other," which,
fays he, mull have been done, " without doubt, by the continual friction of
one againll the other-, and fimilar appearances to this, he might have fomc-
times leen, in calculi of the urinary bladder likewiie, from a fimilar caufe.
Confider alio that large one, which is defcrib'd and delineated by the ce-
lebrated Bechmann (m)> and which, confiding of three parts, had extended
the cyll. When you fee how much the middle part, in particular, cnter'd
into the lower part, and attend to the exact polilh of the furfaces, which
were contiguous to each other, you will, beyond a doubt, affirm that this
was owing to friction.
20. But with how many angles thefe calculi have been furnifh'd, of what
kind thefe angles were, or in what manner they were plac'd, or what figure
they, for the moft part, have put on, it is not eafy to determine from the ob-
servations of others, not only on account of the great variety, that there,
frequently, is even in thofe which are contain'd in one and the fame veficle,
but ftill more, by reafon of the proper fignification, and ftrict fenfe, of words
being frequently neglected, in pointing out the figures, by thofe who ought by
no means to have been thus carelefs, or by the defcription of thofe figures be-
ing neglected, which were proper to give an idea of their form. Indeed when
I read Vefalius defcribing (») eighteen calculi, which he had found in the
cyft of a man, " as form'd in the manner of a triangle, with the fides and
" furfaces every where equal •" I feem to myfelf to have an idea of a tetrae-
drum properly fo call'd.
But on the other hand, when many others call them" triquetri," or " trian-
" gles," or "triangular," I neither know whether they faw them in the form of
a prifm, or a pyramid, nor, whichever form they faw them in, whether compre-
hended under equal or unequal planes. On the contrary, however, when Grei-
felius(o) fays that he had found four pretty large " cubic" ftones, together
with an almoft innumerable quantity of other fmaller ftones, all which, as far as
he could diftinguifh, " refembled a cube-," I have no doubt of his idea:
but I am much in doubt, when many others fay that they were " fquare,"
or "quadrangles," or "quadrangular;" for you fee how many different
fpecies of parallelopipeds may be fignified by thefe words.
However when 1 examine, attentively, all the calculi which I have
in my peffeffion, and I have a great number, I perceive, in the fir ft place,
that it is very difficult to find any perfect regular figure at all, in angular
calculi, and I cannot help believing that Vefalius himfelf, and Greiielius,
rather meant to be underftood a figure, which approach'd very near to that
of a tetraedra, and to that of a cube : and in the fecond place, I think that
(1) Cent. 4. obf. 41. (?,) Epift. de rad. chin,
(w) Commerc. litter, a. 1742. hebd. 32. n. 1. <o) F.ph. n. c. dec. 1. a. 3. obf. 45.
cum tab. 2. fig. 10.
Vol. II. H h thofe
234 B°°k HI; Of Difeafes of the Belly.
thofe who have call'd them triangular, or quadrangular, meant to point out
a figure which comes near in fome meafure to that of a tetraedra, or a cube :
and, finally, I fuppofe that as both of thefe forms, in confequence of not
being perfect, if you fo conceive of them, for the mod part offer fome fur-
faces to the eye, which, at firft fight, feem more like the one, or more like
the other, many have refer'd them to one clafs, and many alfo to the other -r
but if the calculi are examin'd accurately, in every part, I imagine that they
will generally be found of that figure, which was formerly pointed out by
me, in the firft of the EpiJioU Anatomic* (p). And that they have very
often more angles than either of thefe figures requires, that which I there
defcrib'd fufficienrly demonftrates : and Kentmannus (q) has formerly taught,
that they have many more, and the more in proportion, as there are more
calculi contain'd in a cyft j however, though I confefs that the firft fuppofi-
tion does fometimes take place, yet whether the fecond does I am greatly in
doubt •, and even if I attend to fome obfervations of Greifelius, and of my
own, I know that it is not always true.
But let us fuppofe what number of angles we pleafe ; wherever there are
fome very acute, or the furface of the calculi is very rough, they may, if a
confiderable weight is at the fame time added, not only irritate the cyfty
but fometimes alfo burft through it. A very extraordinary inftance of which
rupture you have in the Sepulchretum (r).
But irritation may excite inflammations, ulcers, and excrefcences, which
have been feen even by me (s), and, if with Wepfer (/), we compare the
urinary and gall-bladder to each other, may at leaft bring on a preternatural
thicknefs of the coats. For the urinary bladder " often becomes four times as
" thick as it naturally is, by the continual friction of the calculi upon it,'*
as he fays, and as we (hall fee, in its proper place («). And he alfo found
the coats of the biliary cyft " preternaturally thicken*d," and, as he thinks,
from the fame caufe, as others alfo have fometimes, among whom are not
only fome of my difciples (x), but likewife the very learned Trew fv), who
did not find it without a purulent matter, but, in particular, the celebrated-
Bezoldus (z), who deicribes thefe coats as being " harden'd, thicken'd, and,
in a manner, cartilagineous," although he enquires after a different caufe
from the calculi, which the cyft, in his example, and thofe juft now pointed
out, contain'd ; and certainly a different caufe may, at other times, with fome
juftice be affign'd (a). But the furface of thefe concretions is frequently
fmooth, as Vefalius law in that lawyer, efpecially if they are in the num-
ber of thofe that are yellowifh, which we perceive, even when dried,
to have a kind of greafy fmoothnefs, as if they had been fmear'd over with
foap, an uncluous fmoothnefs of which kind, I have, fometimes, obferv'd to
be ftill more confiderable, in thofe that are of a greenifh colour (£)•
(p) N> 44. in fin. (*) Epift. 42.
(q) Apud Schenck. obf. 1. cit. fupra ad. n. (x) Epift. ad Schrock. de qua: fupra n. iS.
17. (y) Aft. n. c. torn. obf. 140.
(r) L. 3.f. 14. obf. 5. §. 4. (z) Difp. de cholelith* §. 6.
(s) Epift. anat. 1. n. 43. \a) Vid. Sepukhret. 1. 3. f. 21. obf. 4. $. II.
(t) In auftar. ad obf. de apopl, hift. 13. in \b) Epift. modo cit. ad. Schrock.
fchol. n. 5.
2 But
Letter XXXVII. Article 21. 235
21. But as to what I have faid of irritation, there is no doubt but this
imift lake place then alio, when the calculi are form'd within the coats ol
the cyft, provided they are rough, or large. And thus I fuppofe that the
obfervation of Gendrotfius {c), that is of a dyfentery, from a continual dis-
charge of bile into the inteltinum duodenum, may be explain'd, whereas
there were two pretty large, and unequal, calculi in the cyft, involv'd in a
peculiar membrane. And you will fuppofe them to have been generated in
the glands of the cyft, and that being increas'd therein, they had extended
their fituation between the coats, in which Situation thofe glands, alfo, na-
turally lie. For you will remember that fmall biliary calculi were formerly
found, and demonftrated, by me (d), in thofe glands which open'd by very
evident orifices, and were, for that reafon, lets to be call'd into queftion.
And that thefe had been very ingenioufly found out, and acknowledg'd, by
the celebrated Galeati alfo, in an obfervation very fimilar to mine, except
that thofe orifices did not appear, I learn'd afterwards with pleafure, when
the firft volume of the commentaries of the Academy of Sciences at Bologna
was publifh'd (e). And I fhall tell you below (/), that another very fmall
calculus has been obferv'd by me, betwixt the coats of the cyft.
For it is your bufinefs, now, to confider, whether in that obfervation of
Greifelius, which I took notice of above (jf), " the other coat that grew to
** the fund of the cyft, and contain'd a (tone in the form of a cube, that
*' was bigger than any of the others," is to be accounted for in the fame
manner. However, I have very little doubt, but the obfervation of the ce-
lebrated Ellerus may be thus explain'd, which, if I remember rightly I
read fome years ago, in the fourth volume of the Berlin mifcellanies.
For I fhould readily fuppofe that the fmall, round, and yellowifh calculus,
which he found concreted in the fundus of the cyft, and furrounded with a
membrane produced from the pellicles of that bladder, had been form'd in
fome one of its glands. And, indeed, I am alfo inclin'd to think it probable,
that a calcukis, which, from all its appearances, was biliary, had been form'd
in no other place, as the thicker part of it lay hid in a certain facculus, be-
twixt the coats of the cyft, and the other part ftop'd up the neck of the
cyft (b) : fo far am I from believing it to be prov'd by this obfervation, that
the gall-bladder is not furnifh'd with any glands. And, indeed, the cervix
of this cyft cannot be ftop'd up by a hard and thick body of that kind, but
other parts muft certainly be prefs'd upon, which are neceffary to the actions
of the cyft, or the cyft itfelf muft be contracted, and crifp'd up, by the ir-
ritation ; fo that we need not be furpriz'd after this, if the fecretion of its
glands be either obftructed, or injur'd.
You may imagine me to have laid nearly the fame things, in regard to
the experiments of thofe gentlemen alfo, who have tied up the meatus of
the cyft, in the living animal. Thefe glands, therefore, are not taken notice
of by anatomifts, but are known from certain obfervations, many of which
(c) Zodiac, med. gall. a. i. maj. obf. 6. (g) N. 19. 20.
(d) Epift.anat. i.n.56. (b) Hilt, de l'acad. r. des fc. 8. 17S5. obf.
(e) Vid. in opufc. anat. 1.
(f) N. 29. in fin.
H h * kind
236 Book III. Of Difeafcs of the Belly.
kind are mention'd by me, in the fiift of the Epijlola Anatomic a (i). In
which, however, I have not, taken notice of " fome glands that lie very
" near to the cervix" only, unlefs, perhaps, the learned man fuppos'd,
at the time of writing, by a failure of memory, as frequently happens, that
what I have there faid of the urinary bladder, not under number ninety-
fix, but under number fixty-three, was faid in relation to the gall-bladder.
22. Now fince I have faid more than I intended of the magnitude of
cyftic calculi, their number, figure, and fituation, although many things,
among others, that I have faid may be ufeful in order todiftinguifh thefe con-
cretions when they are difcharg'd by ftool •, let us, at prefent, go on to
confider the remaining marks, which are fuppos'd to be more conducive
to this purpofe, I mean their ftructure, lightnefs, and propenfity to take
flame.
As to what relates to the ftructure, from the time in which Kentmannus
(k) afierted that thefe calculi, if you broke them, appear'd, internally, to be
" full of narrow circles furrounding each other mutually, lb that any one
" may obferve, or, at leaft, any one who takes the flighteft notice, in what
tc manner the vilcid, and fluggifh bile, had, by degrees, concreted, and
" become adhefive, from the center quite to the furface," fcarcely any one
has rifen up, who, fpeaking of their ftruclure, and mode of accretion, did
not agree with Kentmannus. Yet were there fome things, which frequently,
and in various calculi, ought, in part, to be corrected, by the help of re-
peated obfervations, and in part have others added to them.
For as to concentric circles appearing in fections, that may be true in
round calculi, whecher they are fpherical, cylindrical, or oval, fo that the
lection, in each of thefe figures, be made according to the perpendicular of
the axis, as in the parts of the calculus, alfo, which are hemifpherical,
conic, or cylindrical, in their form, as you fee, for inftance, in the larger of
thofe two reprefented by Hildanus (/). But if you divide angular calculi
into lections, the external ftrata, of which they are compacted, rauft of
course be far different from the circular form, and the internal ftrata, like-
wife, as far as 1 have feen, will be nearly of the fame kind : and this you
may fee in the figure which is given you by the celebrated Trew (;;/), whom
1 have often recommended..
For thefe reaibns I imagine they have fpoken with more propriety, who,
omitting the figure, have only mark'd out ftrata lying upon ftrata, as Bofcus
(«)>. who has faid that, out of nine calculi, " layers had been concreted to
" each other, in- every one of them, as they are in an onion -," as Hildanus
(o)> who has faid that his " were concreted in laminse ;" and, not to be too
prolix, as Malpighi (p), who has faid " that they are made up of a number
*f of involucra, mutually enwrapping each other ;'* I fay, they have fpoken
with more propriety, than thofe who, when fpeaking of angular calculi, have;
mention'd circles to us, which you will find from the Sepulchretum (q)y was
(/) N. eod. 56. («) De facult. anat. left. 2.
(i) Apad. Schenck. obf. 1. fepius cit. (0) Obf. modo cit.
(/) Obf. 44. cit. fupra ad n. 19. (/) Op. pofth.
(») Commerc. litter, a. 1754. tab. 1. fig. 5. (?) L. 2. f. i. obf. 74.
done
Letter XXXVII. Article 23. 237
done by Otto Heurnius, where defcribing a calculus " of a triangular figure,
" extended into a pyramidal top, he lays that cortical circles appeared there -
" in, lying upon each other."
Nor is it fufficient to correct thefe things in Kentmannus. For among the
black calculi, both fpherical, and angular, which I have by me, the greater
part of them, now, fhow no ftrata at all •, only fome few of the angular, that
are the mod firm, have an external ftratum, but fomewhat oblcure in its ap-
pearance : the remaining fubftance is of fuch a kind, that we mult pardon
the ancient authors, whoever lit upon them, and particularly Picolhominus
(r), for afferting, that " the bile being burnt in the cyft, like a coal, was
" converted into blackifh calculi," and he even might have laid extremely
black, with juftice, if he had feen thefe of mine. And I heartily wifh the
fame indulgence could be given to men, in other refpe<5ts very learned, who,
in the great light of this prefent age, forgetting that, after fo many difeafes,
join'd with very great heat, no ltones are, generally, found in. the gall-
bladder, have imagin'd that fome of thefe, which happen'd to be found
without any bile, were to be afcrib'd to a violent fever that had preceded,
which, having confum'd all the aqueous part of the bile, had converted the
remainder into (tones.
But it is not fumcient to except thefe black calculi, in order to reconcile
with truth, the other things that Kentmannus has faid, I mean that the others
are, at leait, full either of circles, or ftrata of a different kind, " from the
" center quite to the circumference," or as others, in general, fay, ofatt
the calculi hitherto known, that they are made up of concentric ftrata, which
defcend even to the fmalleft nucleus. For I would have you fee what ob-
fervations have been made by me in the Adverfaria (s), in the firft Epiftola
Anatomica (7), and in the letter fent to Schrockius (u), on the nature of the
nucleus, its flftnefs, and its magnitude in particular, in ib many and fo various
calculi, as I am not willing to repeat them here. You will, at leaft, per-
ceive that 1 have found no fmall quantity of meditullium, in proportion to
their bulk, and fo much the greater, in proportion as they were more increas'd,
and that full of a foft, and moift bile, and confequently, that no fmall
part of each of them, internally, is fo far from confifting of thefe ftrata,
that it is necefTary to enquire, by what means the bile can penetrate inwards,
through thele ftrata which are already firm.
You will alfo perceive other things, that are purpofely pafs'd over here,
as, for inftance, that the cuboidal calculi, which I have cut into, do not
confift of fmaller calculi of the fame figure, but, like the others of which
I have fpoken, of bile inverted round about with ftrata : that thefe are of
different colours from each other, and fometimes alternately fo : and, finally,
that they are, not uncommonly, feen to confift of a great number of fmall
lines, going towards the centre.
23. This direction of the lines puts me in mind of a certain ftructure of thefe
calculi, differing from that which Kentmannus has advane'd. Nor has this
great number of fmall lines only, which I jult now mention'd, as being ob-
(r) L. 2. anat. prxleft. 20.. (t) N. 47.
(ij m.,animad.28.. (») Vid. fupra ad'n. za.
fervid
238 Book III. Of Difeafes of the Belly.
ferv'd in each of the ftrata (and which have certainly been taken notice of by
others alio before me, as, for inftance, by Maurice Hoffmann (x), when he
defcrib'd calculi " made up, of ftriated laminse, as it were) been fometimes
feen, but even ftill more evident lines, or fuch as went from the center itfelf,
in one continued courle, to the circumference, as by Baeumlinus (y), who
faw, in calculi, which, in regard to the order of the colours, agree, in great
mealure, as he fays, with fome defcrib'd by me, " faline fpiculae, as it were,**
running from the center to the circumference, " in the manner of ftriae," or
lines, fo that they feem'd to be made up " not fo much of lamellae,** as of
ftriae.
So Trew fz), in like manner, afTerts that in another calculus, " no la-
** mellated ftruifture could be found, but it rather feem'd that radii were
" running out from the centre, to the circumference, though in an obfeure,
" and confus'd manner," which the delineation, that is added, confirms (a).
But Maurice Reverhorlt {b) ; not to omit thofe who wrote before ; when he
delineates the lections of one, or two calculi, out of a great number, that he
had extracted from the gall-bladder of an old man, in one, indeed, fhadows
out a kind of cortex, in the form of a circle, but in both reprefents lines, of
no inconfiderable thicknefs, going, in the manner of radii, from the center,
to the periphery. And John Baptift Contulus (c), having given figures of
ftones, (fuch as they are, and like the reft of his performances) found in this
cyft, and among them, of one found by him, " which was diaphanous at its ex-
" tremities," gives a fection, as it feems, of another, alfo, taken from
I know not where, in which, indeed, are feen many circular ftrata, but a
much greater number of lines, going from the center, to the circumference.
Moreover, I remember a peculiar fpecies of calculi defcrib'd by Malpighi
(ij, which he fuppos'd to have been form'd by concretion, " from a .kind of
" mucous fubftance, that very much refembled foap, or, rather, refembled
M camphor," he fays, therefore, " that they are of a furprizing ftructure,
" for that they refemble the lapis judaicus, and are made up, internally,
M of elegant lamellae, drawn from the circumference to the center, which
" lamellas are eafily feparated one from anodier." And although he fup-
pos'd it to have been generated " in the liver, and in the porus biliarius,"
I believe becaufe he had heard that a ftone, which his friend Bonfiliolus
preferv'd, was found " in the liver" of a nobleman in Germany, yet he could
not, for a certainty, know that another of this kind, which he fays he had
feen, " and which was difcharg'd, together with the inteftinal feces, after great
•* pains, and a long jaundice," by a matron with whom he was acquainted, had
been generated in the fame place. For that fome calculi, which have come
from the gall-bladder, have been, without doubt, difcharg'd by ftool, will
be mown below- ("^j, and that in this cyft alio, concretions are fometimes
form'd, of a ftructure very fimilar to that whereof we fpeak, may not only
(.v) Eph. n. c. cent. 9 & 10. append. 1. obf. (a) Tab. 1. fig. 26.
35. (£>) Difl". de motu bilis tab. 2. fig. 5.
(y) Commerc. litter, a. 1743. hebd. 28. (c) De lapidib. &c. c. n.
n. 2. (<0 Op. pollh.
(zj Ibid. hebd. 36. n. 4. (<?) N. 46.
2 be
Letter XXXVII. Article 24. 239
be conje&urM from what has been already faid, but will be confirm'd imme-
diately, by other obfervations.
For that tranfparent calculus of Vater, which is taken notice of above by
me (/), had not only very (lender, faline, and mining, ftrire on its furface,
but was alio M concreted in the manner of ftrife :" or if there mould be any
doubt about this, there certainly will be none in the defcription, and figures, of
thofe two which I have pointed out from Morand (g). For both of thefe has
fplendid, and pellucid lamellae, the one indeed with ftrata lying round them,
but the other without any, and going, in the manner of radii, from the
centre to the circumference. And, lately, the illuftrious Haller (b) has pro-
pos'd others " which were mining like chryftal, and fcmipellucid," thefub-
fiance of one of which calculi, that was fpontaneoufly broken, *' being al-
** mod like felenites, mining, and ftretch'd out from a yellow center, in the
" manner of radii, to the inverting cortex, was made into cruris, and fmall
** laminae.'* The other calculi, which M were fmaller, were, likewife, in-
* ternally laminated, in the manner of felenites, and mining."
24. All thefe obfervations, join'd with the others, which I have before
mention'd, of mining and pellucid gall-ftones (/), will certainly induce you to
fufpedr. that many of thefe calculi, which are difcharg'd by ftool, have been
too haftily fuppos'd not to have been generated in the cyft, but in the fto-
machy and inteftines, and for this reafon, becaufe they feem'd to be too far
diftant from the more general nature, and ftru&ure, of cyftic calculi. And
one in particular which occurs to my mind, on this occafion, is that defcrib'd
by Donatus (i), from Cornelius Gemma, and which fhow'd, " internally, a
** fubftance like the pureft glafs, or tranfparent chryftal, with many ftriae, and ■
" radii, jointly running into one center."
It feems, indeed, to be an objection to our fufpicion, that this concretion
was " very large." But befides that it will be mown below (7), how much
the biliary duels may be dilated, and even how much they have been found
to be dilated, I would have you believe, with Gemma, from the feat oflong-
continu'd pain, and tenfion, in the right ilium, under the falfe ribs, not that:
k had been concreted in the inteftinum caecum, as he imagines, but that be-
ing delay'd there, in its paflage downwards, it had gain'd a frefh addition of
fubftance, on its external furface, which was partly of a brown, and partly
of a black colour, and by this means had grown into that confiderable
bulk.
So I would have you fuppofe, that another large calculus, whkh is de-
fcrib'd, and delineated, by Bezoldus («), had receiv'd additional ftrata in
its pailage, that were much fewer in number, where " an almoft chryftalline
** nucleus," had been form'd, which feems to be very properly reprefented
in the plates, not without fome ftriae being drawn from the center, to the cir-
cumference thereof. And the difcharge of this calculus, had been preceded
by pains of the right hypochondrium, of a much longer continuance : nor
does Bezoldus, himfelffw), fail to imagine it poflible, that it might have
come from the gall-bladder.
(f) N. 1 8. {k) Cap. 30. cit. fupra ad n. 15.
Q) Ibid. (/) N. 46.
(b) Opufc. pathol. obf. 33. hift. 7. (»») Difp. de cholelitho caf. 2. & fig. 2 & 3.
(/) N. -18. (") Ibid. n. 7,
In
240 Book III. Of the: Difeafes of the Belly.
In regard to the two obfervations, of ftones difcharg'd from the inteftines,
which he immediately fubjoins, the one large, the other fmaller, you will de-
termine as you think mod proper. For the firft, certainly, points out no
feat of the long-continu'd pain in the belly, and the fecond fays not a word
of pain. Yet when you read that a calculus is fpoken of in the former,
whofe " internal mining fubftance fhow'd mere circles, interfered with ftriae,"
and have examin'd the figures of Schroeckius the father, who was the ob-
ferver (o), which agree very well with this defcription ; perhaps you will not
iuflfer even this calculus to efcape your fufpicion. But in regard to the lefler
concretion, of which you will find no more faid by the author, Brechtfeld (/>),
than by Bezoldus, if you enquire whether, as this calculus, like the three
former, and that, moreover, which was feen by Malpighi (q), was difcharg'd
by a woman, it happen'd to be difcharg'd by an old woman, as we know
was the cafe in the three former obfervations •, in regard to this lefler concre-
tion, I fay, it will perhaps be fufficient for you, that it was " internally
" whitifh, and mining, like chryftal," fuppofing, that in a very fuccinct, and
clofe defcription, the ftru&ure might eafily be omitted, which, as in other
pellucid concretions, alio, taken notice of above (r), would, if the flones
had been broken afunder, probably have appear'd to be of the fame kind,
with that defcrib'd in the laft.
But left you mould, perhaps, be liable to indulge your fufpicions with too
much freedom, call to mind, by way of contrail, the obfervation of the cele-
brated Chomel(i): who found a facculus, in a decrepid matron, into which
the coats of the inteftinum duodenum had relax'd themielves, containing a con-
fiderable number of calculi, of which if you read the defcription, when ex-
amined externally, and, at the fame time, know that they were made up, in-
ternally, of ftrata lying round each other, and, pretty near to the center, of
ftriae difpos'd in the manner of radii, betwixt which, white and mining parti-
cles were interpos'd, you may very eafily confider them as biliary concretions.
And yet you muft of neceflity acknowledge, with Chomel, that they were
generated in the fame inteftine, unlefs you would rather chofe to admit one
of the hypothefes, which I fhall mention : I mean, either that this facculus
had communicated with the ductus communis choledocus, where it paffes ob-
liquely betwixt the membranes of that inteftine, and had receiv'd from this
meatus, firft one calculus, and then others, which had relax'd the membranes
by their additional weight •, or that the firft calculus, immediately upon its de-
trufion from the duel:, and its entrance into the inteftine, had, from fome
caufe or other, been detain'd there, and by overloading the coats, and by
forcing them outwards, and downwards, had prepar'd a facculus for itfelf, and
the other calculi, which were to come after.
But although you might, perhaps, confirm both explications, the former
by the example of the facculus wherein were the fame kind of ftones as in the
gall-bladder, which facculus feem'd, to the very experiene'd Galeati (/), to
(») Eph. n. c. dec. I. a. 9. obf. 90. fig. 3 (s) Hift. de l'acad. r. des fc. a. 1710. obf.
& 4. anat.
(p) In ad. med. Hafn. \o\. 1. obf. 100. (.-) Comment, de bonon. fc. inft. t. 3. inter
(q) Supra n. 23. medic,
(r) N. 18.
be
Letter XXXVII. Article 25. 241
bc in that part, where the dudus communis choledocus had, now, cowe
near to its termination : and the latter by the authority of no other perlbn than
Chomel himfelf, inalinik h as lie accounts tor the formation of the hcculus,
from a calculus generated in the inteftinum duodenum, nearly in the fame
manner as you account for it, from a calculus which had fallen therein: al-
though, I lay, you might, perhaps, make ufc of thefe arguments, yet 1 would
not have you l'eem to be too iulpicious.
25. And I could willi that thole marks, which Reverhorft (u) has fup-
pos'd to be quite fufticient, to diftinguifh cyitic calculi, from calculi of the
interlines, were, at all times, in efted, as fuffkient for this purpofe, as they
are, at fomctimes, really ufcful. His words are : ** the proofs of thefe cal-
" culi, that is, whether they really come from the gall-bladder, or not, is
" that thofe which are biliary, not only take flame themfelves, when applied
" to the flame, but, alio, when thrown into water, by no means fink to the
*' bottom, and even fwim upon the furface, by reafon of the oily particles
" of the bile, of whj/ch thefe ltoncs are compos'd."
However, not to inquire here in regard to other biliary calculi, whether
they are to be thus diftinguifh'd from cyftic concretions •, Bidloo (*•), at leaft,
when writing a few years after, " that calculi, arifing from bile, fwim
•• on the furface of water, and are inflammable by being applied to the fire,
*' of whatever colour, figure, or magnitude, they may be," has immediately
added thefe words, utplurimum autem : which mult be fuppos'd to fignify that
thefe marks, though general, are not univerfal, and without exceptions ;
though, whetherthis addition has been taken notice of, by any one of all that
number, by whom thefe words of his are either quoted, or refer'd to, I do not
very well know ; 1 confefs, however, that I myfelf have not attended to them,
before this time.
Befides, to fpeak firft of their lightnefs, as I fhall fpeak hereafter of their
*' inflammability j" Scheffelius (y) admonifhes us, that Reverhorft " is re-
" futed" by Valentine, " not only by a fimilar calculus not fwimming upon
" water, but alfo by cegagropli, or globular concretions, found in the in-
" teftines of wild-goats, fwimming in water, although they are not generated
" in the gall-bladder." But I even find that Otto Heurnius has aliened,
many years before all thefe (2), that three calculi, found by him in the gall-
bladder, " had not fwam upon the furface of water, when thrown upon it,
*' as many affirm they will, but had fubfided." There is no doubt but he
had thofe authors in his eye, whom I have before mention'd (a), as Fernelius,
Riolanus, and others, among whom was, alfo, Hollerius {b). Neverthelefs,
men of the moil confiderable reputation ftill continu'd to follow thefe au-
thors, and Reverhorft, for a long time, out of whom it is fufflcient to 'have
mention'd Ruyfch (c), and Bergerus (d) : nor are fome perfons wanting ftill
to follow them, as they affert, without any exception, that thefe calculi all
fwim in v/ater.
(a) DifT. de motu bil. §. 57.
(x) Vindic. contra Ruyfch.
0) Diflert. de Lithiafi fell. §. 14.
(z) Obf. cit. fupra ad n. 22.
(a) Animadv. ibid, indicata.
{&) De morb. intern. 1. 1. fchol. ad c. 48.
(<:) Thefaur. anat. 5. n. 32.
\d) Phyfiolog, med. 1. 1. c. 14.
Vol. II.
And,
242 Book III. Of the Difeafes of the Belly.
And, indeed, fuch was the fuccefs of the experiments with them : as it was
with others, likewiie, either at that time, or afterwards, as with Cunradus (e)t
Tremelius (/), Trew (g), the Edinburghers (h), and others. But with fome
the experiments did not at all anfwer, as with Jo. Conrad. Fabricius (/'), or
did not anfwer wholly, though in part they did anfwer, as with Lancifi (k),
who faw ten of them " fubfide in wine and water," which very calculi, ne-
verthelefs, " fwam in vinegar," as with Weitbrecht (/), who, in making the
experiment upon the fame number, found, " that if thrown into water, imme-
" diately upon their being taken out from the cyft, they were fpecifically
" heavier than water, but that when they were dried, they became lighter."
I, however, having firft obferv'd fome (?«)» and afterwards a great number,
to fink down in water, refolv'd to inquire whether thefe exceptions could be
reduc'd to any certain heads. And I foon perceiv'd («), that no exception
could be drawn from the colour. I inquired therefore, whether they could
be taken from any other property. But it will be eafy for you to fee, from
thofe obfervations which I have communicated to Schroeckius (<?), how diffi-
cult it muftbe to determine any thing of this nature, in lb great a variety, not
only betwixt different calculi, but alfo betwixt the fame, if you only change
the time, or any other circumftance. Yet when you have read what I have
written on this fubjecl, upon more than one occafion, you will learn fome
hints, that are ufeful to prevent us from forming too hafty a judgment of the
fituation, in which calculi, that occur to us, have been generated; you will
alfo find fome obfervations, which have been fince given almoft in the fame
manner, even by an illuftrious phyfician, whether he had read them in my
works or not
But when you inquire from whence it happens, that fome of thefe calculi
fwim, and others fubfide, whether becaufe in the former is a greater quanti-
ty, and in the latter, a lefs quantity, of the oleofe particles, which, either by
reafon of their certain figure, leaving a great number of fpaces betwixt each
other, or from fome different caufe, are wont to fwim upon water, as we fee
oils and refins in general do, or becaufe the firft mention'd kind of concre-
tions, of whatever matter they confift, have more intervals of this kind inter-
fpersM betwixt their component parts, that is, intervals fill'd up with air, a
very great quantity of which, the celebrated Haller (/>) makes no fcruple to
fuppcfe, from the obfervation of Hales, is actually contain'd in bilious calculi;
I lay, when you inquire into this circumftance, then you will, perhaps, not
be difpleas'd with the obfervations, that I have made upon the bubbles which
are difcharg'd from, or adhere to, them in water, if they fhould happen to
have any tendency to explain the return, in particular, of thofe which, hav-
ing firft fallen down, reftore themfelves again to the furface, or, at leaft, en-
deavour to reftore themfelves.
(c) Eph. n. c. dec. 3. a. 9 & 10. obf. 171. (i) De fubit. mort. 1. 1. c. 20. n. 4.
ad n. 7. 00 Cit. fupraadn. i~.
(f) Act. n. c.tom. 8. obf. 10. ad d. (m) Epift. anat. 1. n. 4.3.
(g) Loco indicate) fupra ad n. 23. («) Ibid. n. 45. 46.
(V) Cit. fupra ad. n. 13. (0) Obf. indie, fupra ad n. 20.
(/) Propemptic. cit. fupra ad n. 15. (/) Ad Bee;, prxled. §. 250. net. r.
2 It
Letter XXXVII. Article 26. 243
It will alfo be of life in your inquiry, to compare my obfervntions with
thole things, which my friend Stancario (q) has formerly hinted, of bubbles
adhering to other immers'd bodies, and of their power in railing them up in
the circumambient fluid, and which Petit, the phyfician (r), has much more
copioufly profecuted. In reading of whom, you will likewife learn the ef-
fect, which heat, added to the water, will have in caufing thofe bodies, that
would otherwife fwim, to d'efcend : anil this circumftance being transferred to
bilious calculi, fliows another caufe, moreover, from whence the experiments
may vary, and would even render thefe experiments, which I, in general,
made in the cold feafons of the year, after the publication of the firft Epiftola
Anatomica, liable to lulpicion with me, if I had not made them with water
juft warm, but not hot.
26. But the reafon of their inflammability is too obvious to need our prefent
inquiry. Yet I do not remember that any mention was made of this proper-
ty, before the times of Cortefius (j), who fays, " it is found by experi-
" ence, that ftones generated in the gall-bladder burn like fat." Who after
him has affirm'd that this property is common to them all, which fome even
ftill feem to believe ; and who has admonifh'd us that this is true of them " in
*' general" only, was mown you a little while ago(//). And what various ob-
fervations I have made upon the burning of different calculi, and what kind I
have feen take, cherifh, and preferve the flame, and what I have feen do the
contrary, is not only faid in the Adverfaria («), and in that Epiftola Anato-
mica (x), but alfo in the latter part of the other letter which I fent to Schroec-*
kius (y).
From thefe writings you will learn many things, but this in particular, that
thofe remarks, which are delivered by a certain celebrated writer in medicine,
in regard to " all" bilious calculi, even all that are in appearance of a certain
nature, are not to be underftood to relate to all, upon which I, and others^.
have made experiments, but to all, upon which he, himfelf, has made them.
There is no doubt but under the fame external appearance, a different na-
ture, and number, of component particles may lie hid, in different calculi:
nay they fometimes do not lie hid, if you examine them with great accuracy.
To that illuftrious man Hallerfz), who chofe to apply a great number of
different calculi to the fire, inftead of throwing them into water, ithappen'd,
that except thofe which he calls calcarious, all the others took flame, and
among thofe the black ones likewife.
But were thefe internally black alfo? At leaft in defcribing them to be
black, in the fecond, tenth, and eleventh hiftories, in the latter, and, in like
manner, in the tenth, he mentions, nothing but an " external cruft," or no-
thing but a " fhell," which were " black •," and in the fecond, he fays " that
** when the outer fhell was taken off, which was black, and thin, a bilious
M yellownefs fucceeded." You find, therefore, from an accurate defcription,
that the nature of thofe which were inflammable in his experiments, was dif-
ferent from the nature of others which, being black, not only externally,
but internally alfo, or internally, in particular, very black, I have faid did
(q) Vid. Vallifner. oper. t. I. p. 6. («) III. animad. 28.
(r) Mem. del'acad. r. des fc. a. 1731. \x) N. 49.
{/) Mifceil. med. dec. 2. c 9. (y) Obf. indicata fupraad n. 20.
(') N. 25. (%) Opufc. pathol. obf. 33.
I 1 Z nos-
244 Book III. Of Difeafes of the Belly.
not take the flame, or when taken, did not preferve it, by which experi-
ments, chiefly, it is made commonly known, that there are fome calculi which
are not inflammable. And to thefe I afterwards added others, though not
black ones, which, in like manner, had not any inflammable principles ; but
of thefe there is no neceffity to take notice here.
27. After making lb long a difcourfe upon thefe calculi, particularly that
they may be diftinguifh'd from other concretions, when difcharg'd from the
body, it becomes proper now, to fay fomething of afcertaining their exiftence,
if poffible, when they lie latent within their veficle, left you fhould fuppofe
that I have forgotten what it was that drew me into this long treatife. For
it was the reprehenfion of him, who had pronounc'd that an obftinate, or re-
turning, jaundice was a " certain" fign of the exiftence of thefe calculi, which
gave rife to my difcourfe. But with how much more caution dots Fernelius
give his opinion (a), who only fays, that we " ought in this cafe to be fufpicious
" of thefe calculi-," and yet he laid this down, in particular, if both the
cyftic ducts, that is the hepaticus, and communis (b), were obstructed.
But, if even a jaundice of that kind, is no certain fign of gall-ftones, it is
not eafy to fay how much thofe gentlemen have been deceiv'd, who have
imagin'd that they could not exift without a jaundice. And, in order to root
out this notion entirely, from the minds of fome phyficians, where it yet
remains, I can with the greateft certainty affirm, that notwithftanding the
whole number of bodies, in whofe gall-bladders I have found calculi, is
nineteen, and the number in which Valfalva found them four, yet not one of
all thefe had been affected with a jaundice. But as three of Valfalva' s obfer-
vations, and as many of mine, relate to letters which I fhall hereafter write to
you (c), you may, in the mean while, turn again to thofe fourteen which I
have already fent you, in different letters (d), and join them with thefe three
that I fhall immediately fubjoin.
28. A poor old woman had receiv'd a violent blow upon her head, by a
fall : of which alone tere all her complaints as long as fhe liv'd ; and fhe liv'd
not a few days, till at length fhe gradually funk away and died. This patient
had no inequality of the pulfe, no traces of a jaundice. And the reafon of
my making this remark will appear, when I tell you what I obierv'd in the
heart, and the gall-bladder, while I was bufied in purfuits of quite a different
nature. For I did not even diffe<5t the body, that I might know what detri-
ment fhe had receiv'd from her fall.
The body was fat, and yet the fkin very hard. In the thorax nothing oc-
cur'd to me that was worthy of remark ; for to fome of thofe who were pre-
fent, it feem'd otherwife, in regard to a polypous concretion, that we found
in the right auricle of the heart, which was whitifh, and if you attempted to
diffolve it with your hand, gave confiderable refiftance, as if we did not fre-
quently fee acruftofthis kind lying on the furface of blood, which has been
taken from a vein, and coagulated, or, as if this woman had been fubject to
(a) Patholog. 1. 6. c. 5. {<T) Vid. ep. 3. n. 4. ep. 4. n.,13. ep. 5. n.
(//) Vid. -ejufd. phvfiolog. 1. 1. c. 7. vid. 6. & 19. ep. 21. n. 2. 5c & 36. ep. 24. n. 16.
etiam infra n. 33. ep. 26 n. 21. ep. 27. n. 2. ep. 30. n. 14. ep.
(t) Vid. epift. 38. n. 20. epift. 49. n. 2. 34. n. 15. ep. 55. 11. 16. ep. 36. n. 4.
epift. 56. n. 7. 9. 3 1. epift. 57. 10.
an
Letter XXXVII. Article 29. 245
an inequality of pulfe, which they are fo fond of attributing to polypi of the
heart.
In the belly, the ftomach appear'd to be almoft double, fo fuddenly was
that cavity contracted, before it came to the antrum pylori.
The gall-bladder was half-full of bile, and, being of a bright yellow like
orpiment, had ting'd all the neighbouring parts with the fame colour. In this
bile were ten calculi, of an- unequal magnitude, among themfelves, but none
ofthemfmall. Other circumllances which relate to them, you will read in
the letter to Schroeckius (e) ; for this is that woman of whom I there fpoke
in the third place, (bowing where, and at what time, I dillected her.
And from thence you may alio learn, in like manner, what relates to an-
other woman, the remaining part of whofe hiftory I mall immediately add :
lor it is (he who is fpoken of, in the firft place, in that letter.
29. A woman fomewhat younger than the former, yet almoft fixty years
of age, who was not only far from having an icteric colour,- but endow'd with
a very good complexion, was much given to drinking, and had been feven
times married : this woman having complain'd of no other diforder, but of
an inflammation of the thorax, of which fhe died, was diffected by me, not
on account of her difeafe, but in order to examine into the abdominal vif-
cera, and had fome appearances in the genitals, but ftill more in the gall-
bladder, which are not unworthy of being tranferib'd here.
The uterus had a tubercle externally, on the upper part of its fundus, of
the figure, and magnitude, of a fmall filbert, partly prominent, and partly
latent within the fubftance of the uterus, of a icirrhous hardnefs, of a white
colour, both internally, and externally, and confifting of many different
fmall parts which, in fome meafure, refembled cells contracted into them-
felves. And within the cavity of the uterus, from the middle and anterior
part of the fundus, rofe up a foft, and almoft gelatinous excrefcence. But
although the teftes, as was to be fuppos'd from her age, were much
fhrivell'd, and very narrow, yet the cervix uteri, and vagina, appear'd diffe-
rently from what you would have expected in the wife of feven men. For in
the latter part, were ftill a great number of rugas, prominent, even to half
the extent of it, longitudinally •, and in the former, the figure approaching to
that of a virgin-cervix, and the valves, which were preferv'd on one fide, made
me fuppofe, that flie had been the mother of very few children, which was
alfo confirm'd by the (lender rugse, in the lower part of the abdomen.
But as to the gall-bladder, although it was much fhorter than in proportion
to the magnitude of the liver (which was, in other refpects, of its ufual found
appearance) for it did not reach, with its fundus, fo low as the edge of the li-
ver, but was diftant therefrom by almoft two inches ; it neverthelefs contain'd,
together with a fmall quantity of bile, at leaft three hundred and thirty cal-
culi, which were chiefly very fmall, as the fhortnefs of the cyft, that I have
defcrib'd, would of itielf argue. As to the other remarks I made upon thefe
calculi, I have (aid juft now (f), where they may be met with : although in
that letter, not only many typographical errors are admitted, but in the part,
in particular, to which I refer, more than one whole line is omitted. Befides
) Vid. in aft. n. c. torn. 2. ob. 167. (f) N. 28.
the
246 Book lit. Of Difeafes of the Belly.
the great number of calculi which I have mention'd, and which occupied tfie
cavity or' the cyft, I difcover'd one with the knife that lay hid between the
coats of this veficle, which, in the blacknefs of its colour, and the fmallnefs
of its fize, was very much like thofe that I took notice of above (g), as hav-
ing been found in the glands of the cyft, at other times \ yet the orifice of the
gland was not fo evidently laid open here.
30. The body of a very old man, who had been by trade a moemaker, and
who, by reafon of his great age, was almoft toothlefs, and had died partly of
old age, and partly of a catarrh, within the fpace of three days, but without
a fever, as was faid, and certainly without a iaundice, as was manifeft from
the whitenefs of his fkin, was brought into the college about the end of Ja-
nuary, in the year 1744, when I was teaching anatomy. As the whole of his
body therefore, was carefully difiected, I will here relate all the preterna-
tural appearances which I faw, beginning with thofe that were obferv'd lad
of all.
The upper part of the cranium being taken away with difficulty, by rea-
fon of the very clofe adhefion of the dura mater, fo that the external la-
mina of this membrane remain'd fix'd to the os frontis, the cerebrum and
cerebellum were both of them found to be pretty loft, and ibmewhat brown
in the medullary fubftance : the three ventricles of the cerebrum were full
cf pellucid and pure water : the plexus choroides were pale : the pineal gland
was diftended into the form and magnitude of a middle-fiz'd grape, by a
watry humour, as it feem'd : but the glandula pituitaria, if you look d down
upon it from above, was contracted, and funk in its fituation. The arteries
that run upon the bafis of the cerebrum, though they were net diftended with
blood, like the fanguiferous veftels within the ventricles, but were even-
empty, appeared neverthelefs, both in their trunks and branches, to be wider
than they naturally are.
In the cavity of the thorax was a fmall quantity of turbid and brown wa-
ter. The lungs were collaps'd, and fallen down to the back, in confequence
of their being almoft quite disjoin'd from the pleura. As the heart was
larger than it naturally is, fo the trunk of the aorta was alio wider. And
the valves prefix'd to this veflel, at the aggeres, as Valialva call'd them>
were become bony ; and even one fide of one of them confided of a bony
fcale. But although through the whole trunk of the aorta, on its internal
furface, and even the iliac branches of it, a whitenefs was much more fre-
quently propagated, here and there, than bony fcales, yet I faw one of theie
in the curvature, and another near the third pair of lumbar nerves, neither
of them very fmall, and both intercepted, by the internal membrane of
the artery on one fide, and on the other, by the flefhy annular fibres: and
indeed there was a perfect ofiification at the divifion of one iliac artery, into
the external, and internal.
Befides, as the trunk of the aorta itfelf began to bend its courfe towards
the left fide, below the emulgcnts, and return again to the right fide, be-
fore it gave off the iliacs, fo the fame kind of dilbrder, or unufual appear-
ance, was continu'd into the iliac veffels, to fuch a degree, that, by their
frequent
Letter XXXVII. Article 30. 247
frequent flexions, they nearly refemblcd the fplenic artery. Nor were the
tids, and vertebrate, entirely tree from this irregular difpofition. And
thele- flexions of" the branches prevented me from attributing the incurvation
of the trunk, juft now defcrib'd, altogether to the contiguous exoflofes of
the lumbar vertebrae, the appearance of which was as follows.
1 hole thick ligaments, that are interpos'd betwixt the bodies of all thefe
vertebrae, except the lower, were lb prominent on their anterior furface,
and efpecially on each fide, like an air-bubble, that thefe prominences, on
the right, and on the left fide, were almofl equal to the breadth of my little
finger. All the prominences on the left fide, whether becaule they had be-
gun to be form'd beiure the others, or from what other caufe foever,
were bony. But of the right, that only feem'd to be bony, which cor-
refponded to the interval betwixt the third and fourth vertebrae; yet it
was not lb; but a bony lamina, that form'd the furface of the body of the
fourth vertebra, lifted itfelf above the level of the vertebra;, and in its ele-
vation was alio produe'd upwards, by which means it cover'd that promi-
nence over with a bony crult : under which cruft the nature of the prominent
ligament was preferv'd. When 1 cut aiunder one of the prominences on the
left fide, with a chifel, and the ligament, that was continued therefrom, with
a knife tranfverfly, thofe concentric lines it is true appear'd as ufual ; but
.every thing was ting'd of a pale and almofl cineritious colour.
At length, the other contents of the belly offer'd the following things
that were worthy of oblervation. The omentum was annex'd, on the right
fide, not only to that part of the inteftinum colon, which is neareft to the
beginning of it, but alfo to the fmall inteftines, that lie in the neighbour-^
hood of that part, and to the peritonaeum. The ftomach was not only more
narrow than ufual, but even was not a good figure. And the ring of the
pylorus was fomewhat fvvell'd in two places. Near to the other orifice, a cer-
tain roundilh, and fmall kind of gland, was internally prominent, into the
cavity of the ftomach, which, when cut into, was found to be an encyfled
tumour ; inafmuch as it was made up of a fubflance that was white, firm, and
compacted into one body, of the fame figure; but this body could be very
tafily disjoin'd from the thin membrane, in which it was contain'd.
The orifice of the ftomach which was neareft to this tumour, that is the
Jlomackus, as the ancients call'd it, was extremely large, as the gula which
is continued therefrom was alfo, to the height of, at leaft, four inches above
the ftomach, in the whole of which tract it was more red, internally, than
the other parts. And indeed 1 law that the foramen, which is open'd in
the feptum tranfverfum, in order to tranfmit the oeibphagus, was much
bigger than ufual, particularly in its breadth, and that it terminated, at its
upper extremity, by a right line tranfverfly, inftead of an angle.
When I examin'd that part of the omentum, which adheres to the ftomach,
with diligence, I obferv'd, on the left fide, not far from the fundus of this
vifcus, a kind of very fmail fpleen, like a gland, receiving its fanguiferous
vefiels from the omentum, in which it was, and very much fimilar to the
fpleen in its colour, its coat, and the modification of its fubflance, unlefs
that this lad was fomewhat more moift than that of the fpleen, and of fu.ch
a figure, and magnitude, that it might be compar'd with the fpleen of a mid-
dk-iiz'd hen. Belides this, another fpleen was not wanting, which was
found,
248 Book III. Of Difeafes of the Belly.
found, and correfponded with the fizeof the liver, that was, likewife, found,
and of" its uilial magnitude, or perhaps a little lefs.
In the gall bladder, together with a fmall quantity of vifcid bile, were fix
or feven calculi of no very fmall fizc, the fargeft of which was not lefs than
a middle fiz'd grape, pretty nearly round in its figure, yet of an unequal
iurface, as if from other very fmall calculi adhering to it. If you except
fome very fmall points of a yellcwifh colour, that were fcatter'd up and
down, through this furface, they were all, both internally, and externally,
extremely black, and refembled a char-coal, not only in their colour, but
even in their very fubftance. Moft of thefe, after they were dried, fell into
fragments fpontaneoufly. And although they, before, feem'd to be light,
yet thole which were thrown into watei\ immediately fank to the bottom •,
and thofe which were applied to the flame, could neither by any means be
made to partake of that flame, nor yet be diffolv'd in any part of them. One
of the leffer of thele calculi was in that part, where the veficle begins to
contract itfelf into the duct ; yet it had not prevented the difcharge of the
bile, as we obferv'd by compreffing the cylt before we cut into it.
Finally, there being nothing in the kidnics worthy of attention, we open'd
the urinary bladder, on the pofterior furface of which, above the orifice, ap-
pear'd a kind of white protuberance, like a fmall inverted pylorus, fomewhat
larger, in its fize, than the feminal caruncle was, to which it extended itfelf;
yet the lower part of that protuberance, being contracted into a low and {len-
der line, was prominent into the beginning of the urethra, and continu'd to
the proftate gland ; fo that as it was of the fame fubftance of which this gland,
confuted, it feem'd, beyond a doubt, to every one who was there prefent, and
very much practis'd in the diffections of thefe parts, that it was an excref-
cence of the proftate glands.
31. I heartily wifh, as I have remark'd all the preternatural appearances,
which were in the body of that old man, (for this reafon, at leaft, that no-
thing fhould efcape you, which, fometimes, may happen to be the occult
caufe of a confiderable diforder) that we were not in the dark as to the effects
of them, or the greater part of them, which had preceded in the living body.
But it is fufficient, at prefent, to have known this, that although the gall-
bladder contain'd thefe calculi, the man had, neverthelefs, not been icteric,
any more than the women I have before defcrib'd, and lb many others pointed
out above (h). Which, if it had happen'd to me only to obferve it, I could
the more eafily forgive thofe who ftill hold a contrary opinion, for neglecting,
or affecting not to know.
But befides the obfervations of men of gravity, and authority, which I
have produe'd in a former work (7), and thofe of Valfalva, that I have re-
fer'd to (£), there are fo many others over and above, that I believe it is
fcarcely poffible for me to enumerate them all. Let it be fufficient there-
fore, to have added fome to thofe formerly taken notice of. Laslius a Fonte
(I) fays, that in the body of a bifhop, who was an old man, " the gall-blad-
" der was found full of light ftones, and yet that he had never been at-
(b) N. 27. {k) Supra n. 27.
(/) Epifh anat. l. n. 50. 51. (I) Confukmed. 139. in fin.
" tack'd
Letter XXXVII. Article 32. 249
" tackM with a jaundice." Pechlinus (m) teftifies the very fame thing of an
old woman, and of a woman who was publicly executed at Lcipfic, Etmuller
(;/), as fhe had " in her gall-bladder, great plenty of large, and imall
" ftones," and our Vallilheri (c) aliens that he had, at one time, found
many bilious calculi, and, at another, one large calculus, in the carcafes of
many perfons who had " never" been affected with a jaundice.
How many cyftic calculi" Baeumlinus (/>) found in that woman, in whom
" any thing icteric" had not appear'dj how many Fabricius (q), in a woman
who " in all appearance was healthy •," and, finally, how many Hallcr (r)
found in another, who feem'd to be " very healthy," and, like wife, in an
old woman, in whom were " no figns of jaundice," you may yourfelf lee : nor
indeed will you fufpect, I fuppofe, that in a great number of other hiflories,
given by this author, wherein there is no mention of the jaundice, this difor-
der, probably, might not have been wanting, when you obferve that, where
he collects the fubftance of them together, he fays, thefe calculi " were, for
" the moil part, unattended with a jaundice, as wa3 certain from his own
" experience (s)."
Others, and among thefe Vaterus (t)-, I purpofely pafs over, fince to the
authors that I have nam'd, it is neceffary not only to add thofe whom I
fhall prefently (u) bring to bear witnefs, that they had feen no kind of dis-
order whatever, join'd with thefe calculi, but thofe alio who, in describing,
or making mention of, other fymptoms, or diforders, of perfons in whom
were cyftic calculi, have pafs'd over the jaundice entirely, though a diforder
that muft have occur'd to their eyes, even in fpite of themfelves : and in the
number of thefe do not imagine there are only Reverhorft (x), Contulus (y)y
Riedlinus (z), Hoffmann (a), BalTius (£), and others of the more modern.
Do but turn to the Sepulchretum. You will find Bonetus (c), Morton (d)y
Greifelius (<?), Kentmannus (f), Huldedreichius (g), Cnoffelius (£), and
others •, for I have not time to refer you to every one of them, in particular,
in reading of whole hiftories I could not fuffer myfelf to fuppofe, that they
would fo readily have pafs'd over the jaundice, if their patients had been af-
fected therewith.
32. How is it then, you will fay, that there are fo many witnefTes on the
other hand, and produe'd even in the Sepulchretum itfelf, that have feen this
diforderjoin'd with cyftic calculi ? Not for this reafon, certainly, that if thefe
are fuppos'd to exift, the other muft neceffarily be fuppos'd to exift alfo.
For if fo, this diforder muft have been feen attending upon thofe calculi by
all. It muft therefore be for fome other reafon. Thus, for the fake ofex-
(m) Apud Scheffel. dirt", cit. fupra ad n. 13. (y) Loc. fupra ad n. 23. cit. c. 25.
$. 16. (x.) Eph. n. c. cent. 3. obf. 45.
(n) Prax. 1. I. f. 17. c. 3. art. 4. («) Cap. fupra aa n. 15. cit. obf. 1.
(0) Adnot. cit. fupra ad n. 13. \b) Dec. 4. obf. anat. 9.
(/>) (<-) L. 2. f. 4. obf. 35.
(?) Loc indie, fupra ad n. 23. (d) S. 7. obf. 43.
(r) Opufc. pathol. obf. 33. hift. 7. & 1 1. (e) S. 1 1. obf. 46.
(/) Ibid. hill. 10. (f) L. 3. f. 7. obf. 33.
(/) DhT. fupra ad n. 16. cit. thef. 9. (g) S. 14. obf. 36.
(«) N. 38&feq. (b) S. 17. obf. 14. §. 5.
(x) Difl". fupra cit. ad n. 16.
#ol. II. Kk ample,
250 Book III. Of Difeafes of the Belly.
ample, and not to depart from the Sepulchretum, you have in the obferva-
tion of Helwigius (/.), a jaundice with thefe calculi, and with a liver, at the
fame time, lank, fhrivel'd and putrefcent : you have them alfo in the ob-
fervations of Vefalius (£), and Verzafcha (I) ; but then you have alfo, at the
fame time, a liver that was enlarg'd, hard and green, or fcirrhous, yellow,
and pallid.
There is, at one time, inftead of this kind of difeafes another difeafe, as
when Beckerus (tn) defcribes calculi, found not only in the gall-bladder, but
in the pori choledoci, in like manner. And at other times there are both of
ihem. Thus Deodatus («j, and Dobrzenfkius (0), relate that there was an
indurated liver, at the fame time that there were calculi, both in the cyft,
and in thofe ducts. And it is not furprizing, that the matter of the bile
mould remain in the blood, and produce the regius morbus, when the liver
can neither fecrete it, nor diicharge, from its own fubftance, that which is
fecreted, without preventing the fecretion of the reft. And that to this clafs
alio, the old obfervation (p) ought to be refer'd, which was taken from the
mother of a profefibr at Bologna, you would readily perceive, if the whole
of it were produe'd.
You however muft read this, as you will that of Vefalius which I juft now
pointed out, twice over in one and the fame fection ; for it is that very ob-
fervation (who would at firft believe it) which is produe'd even below (q):
as you will eafily find out by comparing one with another, and by comparing
them both with that which had been given in another fection (r), or rather
with the pafTages of Coiterus (j) relative to this fubjedt, who is the author
that took the obfervation •, for although it is ib many times repeated in the
Sepulchretum, yet the doubt of the author is always neglected, which for
many reafons ought not to have been omitted ; for he did not fay " fhe had
" labour'd under the jaundice" but "(he had, if I am not miftaken, la-
." bour'd under the jaundice.'*
You fee, therefore, that the teftimonies produe'd are weaken'd, if any one
attends to them rightly, and that their number is, at the fame time, diminifh'd,
when it is demonftrated that one fingle teftimony is produe'd twice over, as
if it had been a double atteftation. Thus you will alfo find the obfervation
of Timasus (/) repeated, juft as you will that of Guarinoni (»), and others
perhaps : but in none will you be more furpriz'd, than in that of Fontanus
(x), which, having been juft before given under number twenty-two, is im-
mediately given over again in every fenfe, and effect, and indeed almoft in
the fame words, under number twenty-three.
Yet the two laft obfervations relate to quite another clafs, than that of
cyftic calculi being join'd with the jaundice indeed, but, at the fame time,
with either a considerable diforder of the liver, or an obftruction of the bi-
(/') Ibid. f. 7. in additam. obf. 1.
(&) S. 18. obf. 8. §. 4. cum obf. 20.
(I) Ibid, in addit. obf. 6.
\m) Sed. ead. obf. 8. §. 1.
(>;) Ibid. $.10.
(0) S. 16. obf. ;.
(j>) S. 18. obf. 8. §. 5.
(q) Ibid. obf. 25. §.6.
(r) S. 8. obf. 36.
(s) Obf. anat.
(t) S. 18. obf. 8. §. 11. &obf; 25. §. 4.
(u) Ibid. obf. 33. St in additam. obf. 5.
(x) Sett. ead.
J^ry
Letter XXXVU. Article
25*-
liaTy canals, to which the two former, and fomc others much more recently
publifh'd, belong. And one of thefe, if it be produe'd, may eafily have its
tcllimony leffen'd in a different manner •, as when Yatcrus (y) lays that a
matron, in whole cyft he found thirty calculi, had labouiM under the jaun-
dice. For this we confefs ; but we at the fame time attend to what he im-
mediately fubjoins, that being freed from the jaundice, fhe had liv'd about
three and twenty years in a- itate of perfect health, and was at length carried
off by an apoplexy. For if fhe had been attack'd with the jaundice, merely as
the effect of calculi, lying hid in the gall-bladder at that time, fhe would
not have pafs'd fo long a fpace of time as three and twenty years, during
which the calculi not only exiited, but were even increas'd, without being
troubled with the jaundice.
And an anfwef of the fame kind you will naturally give to them alfo, who
would object the obfervations of Weitbrecht (2), and Galeati (a). For both
of them found calculi in the gall-bladder after a jaundice which had long
preceded : although you may alfo give this anfwer, that by the firft the liver
was found to be lomewhat hard, at the fame time •, that by the fecond it
was found to be confiderably hard, and crowded with a great number of tu-
bercles ; to fay nothing of thofe things that I hinted at above (£), from
whence you may perceive, that different calculi may have been formerly in
different fituations, fo as eafily to prevent the bile from flowing into the in-
teftines at that time.
But if any one fhould oppofe to thefe examples, others, in which not only
a preceding jaundice, but a prefent one, was join'd with cyftic calculi, as
thole of Lanzonus (r), du Verney (d), Van Swieten (<?), Haller (/), and other
celebrated men, you have wherewithal fufficiently to reply, from what has
been juft now faid. For the firft law the liver, at the fame time, " befet
" with a great number of hydatids ," the fecond fo dried up, in one half of
its fubftance, that it did not equal the thicknefs of a thumb, the third, " pal-
" lid, hard, without moifture, and rough with fcirrhous tumours ,"
and the fourth, finally, although in fo many hiftories he only exhibits two
of icteric bodies, the fecond, and the ninth, yet in the former defcribes the
fame vifcus as being " difeas'd, and ulcerous," and in the latter, as being " in
" great meafure putrid, the gall-bladder being wholly confum'd, fo that the
" calculus was found in the midft of a putrid jelly as it were." And I
fufpedt that if other obfervations, of fome authors, that are produe'd, had
not been made haftily, and by-the-by as it were, but had been taken, and
communicated to the public, with great accuracy, it would have happen'd
frequently, that we fhould read of other marks of difeafe being found in the
neighbouring parts, and particularly in the liver, within which, unlefs you
iearch after them, they may even lie hid.
Obfervations that are ftill lefs recent, are fometimes produe'd likewife ; but
to confefs the truth, to very little effect, as, for inftance, that of our Domi-
(>■) Thef. 9. cit. fupra ad n. 31.
(z) Cit. fupra ad n. 17.
,-0 Cit. fupra ad n. 24.
Ibid,
(c) Eph. n. c. dec. 3. a. 3. obf. 36.
(d) Cit. fupra ad n. 13.
(e) Ad §. 950. cit. fupra ad n. 15.
(f) Opufc. pathol. obf. 33.
K k 2
nic
252 Book III. Of Difeafes of the Belly.
nic de Marchettis (g), as if he had faid that he had feen a jaundice from cyftic
calculi. But he, when he fays " the veficle being obstructed by any matter,
" or by a (lone, (for I have fometimes found in this veficle, three or four
" (tones of the bignefs of a vetch) a yellow jaundice is brought on ■" lays,
indeed, that (tones had been found there by him •, but that he had found
them in fuch a fituation as to obftruct the meatus of the veficle, and for
that reafon bring on jaundice, he certainly does not fay.
33. But fetting afide all thefe, and other fimilar obfervations. on account of
thole animadverfions which I have hitherto hinted at, as fome (till remain to
which none of thefe objections can, perhaps, be made, you will enquire of me, in
what manner calculi of the gall-bladder may, fometimes, bring on a jaundice
in human bodies, and whether in that manner which Marchettus and others
have imagin'd, if they obftruct the veficle, or rather the cruel: which is pro-
per to it, that is the cyftic duel:.
For that the cyft has been obftructed without a jaundice, is certain even
from the obfervations which I took notice of above (h) for inftance, when it
was full of (tones. And altho' when it is full of thefe it can difcharge no bile,
and confequently it comes ju(t to the fame thing, as if the meatus were
really (hut up ; yet to fatisfy you I will produce, below (z), obfervations of that
meatus being (top'd up, without a jaundice •, but here I will only call to
mind what is demonftrated above (k), that it is not through the ductus cyfti-
cus, but through the hepaticus, and communis, that bile is fent from the
liver to the inteitines •, fo that unlefs thefe paffages be obftructed, either by
an excrefcence, or by fome conftriclion, or by a vifcid, and thick matter, or by
calculi, generated either in thefe paffages, or in the liver, or even in the cyft,
but pu(h'd down into thefe paffages, the bile cannot be retain'd in the liver,
on account of the biliary paffages -, and therefore the matter, by which this
fluid is conftantly fupplied, cannot be retain'd in the fanguiferous veffels, in
order to bring on a jaundice.
Yet we mud be cautious, left at any time we fall into errors, in regard to
the words which are us'd by ancient obfervers, to fignify the ductus hepati-
cus, or communis, and fuppofe them to mean the cyftic duct inftead of the
other. For they, according to the tenor of the opinions of their times, took
either one or the other of thefe ducts for the meatus of the cyft, as I have
even ihown before (/), in explaining a paffage of Fernelius ; and the cyftic
duct, as you may fee in Mundinus (m), they call'd by the name of collum
veficula or neck of the gall-bladder, and not by the name of pore, meatus,
or duct.
Therefore, when you read in Donatus (»), of Albucafis having taught, and
Nicolus having confirm'd, " that a flefhy excrefcence arifes in the meatus of
" the gall-bladder, which, by (topping it up, is the caufe of an incurable
" jaundice," although I have faid (0) that this has even been found by me
formerly, in the veficle itfelf, yet do not be hafty to believe that the excref-
cence, of which they (peak, was fuppos'd, by them, to be form'd in this
(t) Anat. c. 4. (/) N. 27.
(b) N. 31. (m) Anat. ubi de kyfti fell.
(i) N. 39. (n) De med. hill, mirab. I. 5. c. 3.
(J) N. 10. {0) Supra n. 20.
veficle,
Letter XXXVII. Article 34. 253
veficle, or in the cyftic duct, inafmuch as it mull have ftopp'd up foine Other
pullage btTules this, in order to have been the real caufe of a jaundice.
Thus when Gentilis, as is hinted at above (p), has afferted that he had
found a ftonc M in the pore, or meatus, of the gall-bladder-," you mud eon-
iider what you are to underftand tlicreby. The very reading of the Sepul-
chretum will render vou cautious in this refpect, where Camenicenus (q)
writes thus to Mathiolus : " the meatus which goes from the gall-bladder,
" into the liver, was quite free and open," that is the hepatic duel'. And
he had laid a little before, " the meatus going from the gall-bladder, and
" terminating in the inteltine, was obllructcd by a ftone :" and that this was
not the ductus cyfticus, but the communis, you may be affur'd not only
from what has been laid, but alio from this circumftance, that in the icteric
body in queftion, " the gall-bladder was extremely full of bile."
Nor will you understand differently, thefe. words in the obfervation of
Coiterus (r)t " in the paflage from the gall-bladder, to the duodendum,
" was a large calculus, which totally obstructed that pafTage, on all fides,"
efpecially when you oblerve that the folliculus fellis is fo defcrib'd by him-
felf (s), in another place, that without making any mention of the cyftic
duct, he lays " it is provided with two pores, or palTages, one by which
" it draws bile from the liver, the other by which it tranfmits the bile,
" from itfelf, into the inteftinum duodendum." For there is no doubt but
he has follow'd the dogmas of his preceptor Falloppius (t), in that point, fo
as to confider the ductus cyfticus in the manner the ancients did, that is as
the neck of the bladder ; yet not fo far as to acknowledge, that the bile was
carried from the liver, to the inteftine, by one meatus, and that a ftrait one,
" on which meatus, about the middle of its courfe, nature has planted a
" bladder with its neck."
34. It is not the cyftic duct, therefore, but the hepatic, which (for though
we acknowledge it to be one, yet for the fake of cuftom, and more clear
doctrine only, we divide it into the hepaticus and communis) I fay it is not the
cyftic, but the hepatic, which we require to be obstructed, either by an ex-
crefcence, or by a calculus, wrhich has even been frequently obferv'd there by
Falloppius (u), or by a thick and vifcid matter, in fome other manner, in order
to make us confefs, that the jaundice has ariien from the diforder of the
more considerable palTages of the bile. For that they may be obftructed, not
only by vifcid, or thick matter, but even by the bile itfelf, I do not doubt,
as I formerly found, in a dog that had been much diforder'd, the extremity
not only of the pancreatic duct, but, alfo, of the ductus communis, fhut up
by means of a kind of gypfeous, and ycllowifli matter, concreted there : and we
read Etmuller (x) describing, in an icteric body at Leipfic, " the lower pore,
" or meatus, entirely obstructed by a vifcid pituita, fo that after cutting av/ay
" this biliary meatus, not lb much as a drop of bile fiow'd out, becaufe the
" bile, which was contain'd there, was very thick, and tenacious.
(p) N. 15.
(q) L. 3.f. i8.cbf. 8. §. 12.
(r) Ibid. f. 8. obf. 36.
(s) Tab. intern, hum. corp. part.
(t) Obf. anat.
(*) Ibid.
(v) Ait. fupra cit. ad n. 31.
But
2 54 Book III. Of Difeafes of the Belly.
But I know that you may take occafion to interrupt rfie here, and enquire
why then the noble Frenchman, whom Scultetus (y) diffected, as he had
*' theporus biliarius, in that part where it is inferted into the duodenum, fo
far obitructed with a ftone, equal to a large pea in its fize, that not the leaft
M quantity of bile could be thrown out thereby," had not, neverthelefs, been
affected with a jaundice? And in fo fingular a cafe, unlefs I fhould choofe
to have recourfe to thofe conftitutions of the blood (z), in which the matter
that fupplies the bile, and even the bile itfelf, can fcarcely give any tinge of
ydlownefs, I am under a necefTity of fuppofing that there was fome peculiar
difpofition of the biliary pafiages : fuch, for inftance, as Falloppius (a) af-
ferts had been feen by him, two or three times, that is to fay, the ductus
communis " divided into a double canal," a little above the inteftinum duo-
denum : which divifion, but betwixt the coats of the fame inteftine, " into
M two confiderable branches, that open'd by feparate orifices, within the in-
" teftine," was once feen, likewife, by Abraham Vater (b).
For fuppofing one of thefe orifices to be obstructed, a pafiage dill remains
open through the other, for the bile to go to the inteftines. There alio
might be fome other more uncommon duct, like that which Veflingius
found, and was examin'd by Bartholin (c)t in a woman "of a good habit,
" fat, and pretty healthy," when the cyft was ftufi'd up, and obitructed,
by calculi, and which " went from the liver, in the neighbourhood even of
" the porus biliarius, that was fill'd up with calculi, and terminated in the
" inteftinum jejunum," or that which Bezoldus defcribes, as being feen
by him (d), and which, according to the figure he gives of it, is very fi-
milar to that of Veflingius, provided it did not go to the ductus communis,
but to the inteftines, or thofe that the fame author takes notice of (e)
as having been demonftrated by Diemerbroeck, which were produe'd, fe-
parately from the ductus communis, betwixt the veficle and the inteftines $
To that a great part of the bile might either be carried immediately to the
inteftines, in a direct pafiage, or through the more general pafiage of the
ductus communis.
But as to the obfervations of Andreas a Lacuna, which he immediately
fubjoins, and which, in part, relate to thofe obfervations that I have refcr'd
to above (/), of ftones being form'd, by concretion, in the cyft, without a
jaundice, and, on that account, produe'd in the firft of the Epiftolas Ana-
tomical (g), if he could have read them rather in the words of the author
himfelf, than in thofe of Riolanus, he would have chofen to make ufe of
the words of the former, in preference to thofe of the latter, inafmuch as
Riolanus, by a flip of his memory, has related three things in three lines,
that by no means agree with thofe which Andreas had faid. But let us omit
thefe confiderations, and go on to others.
3$. As I advane'd four kinds of caufes above (£), by which the commen, or
(y) Obf. cit. fupraad n. 18. (J) Did", decholelitho §. 6. &fig. i. litt. f.
(z) Vid. fupra n. 9. \e) §. cit.
(«) Obf. cit. (f) N. 31.
\b) Diflcrt. qua nonum bilis diverticulum fg) N. 50.
&c. thef. 7. (/;) N. a.
//) Cent. 2. hilt, anat.' 54.
hepatic,
Letter XXXVII. Article 35. 255
hepatic, canal may be obftructed, but produc'd examples of three only, you
may perhaps wonder why 1 have produc'd no obfervation of the fourth, that is
of confiriction. But you will ceale to wonder, when, in reading over again the
pre lent very prolix letter, you obicrve this to have been done already (i), as
far as was pofiible, by examples pointed out from the Sepulchretum. But if
you inquire at'ter other inltances, from different authors, they are by no
means wanting. That is a very famous one, by reafon of the eminence of
the patient, which was taken from Andrew Mauroceni, a noble Venetian,
who was illuftrious both as a llnator, and as an hiltorian, and which is given
us by his learned phyfician Aurelio I'alazzoli (£). For the cauie of the
jaundice, of which Mauroceni died, was an infuperable conltriction of the
paftages; inafmuch as " the duel: by whicli the bile is, chiefly, carried to the
M intellines, had become callous."
Mead (/), alio in a body that had been troubled with an obftinate jaun-
dice, law the fame meatus, where it makes a coalition with the cyclic duel,
fo contracted, as if a ligature had been made upon it, that " it would not
" admit a probe ;" nor could any portion of the bile, with which the gall-
bladder and liver were diftended, pafs on, by this way, to the inteltines:
and this contraction feem'd to have been brought on by a fcirrhous, and even
a cancerous, tumour of the neighbouring pancreas. And in the ads of the
Calarean Academy (;;;), an obfervation is extant of an icteric body, in which,
by reafon of a fcirrhous pancreas, the fame common canal was fhut up at
its termination, not without " a firm concretion."
Examples of the more rare caufes therefore, which, either by condenfing
the tube into a folid body, or by preffing upon it externally, conftringe the
common duct of the bile, I have neither been backward to produce above,
nor in this place, and fhould do the fame in regard to the more frequent
caufes of conltriction, if the effects of thefe were as eafily obferv'd by the
fenfes, after death, as they are probable from reafon, and agreeable there-
with. I fpeak of fpafmodic crifpatures^ by winch, at lead, the orifice of the
common duct, or the greater part of the final 1 branches of the hepatic, are
conltring'd : unlefs we fhould fuppofe that the obfervation of the celebrated
Jo. George Maurerus {n) relates to this fubject.
An illuftrious man, after a wound receiv'd in the region of the liver, which
did not penetrate, being feiz'd with a bilious tertian fever, and a jaundice, and
after that with other diforders, yet giving hopes of recovery, and in regard to
the jaundice itfelf, being almoft quite recover'd, but having a violent, repeated,
and long uneafinefs of mind come on, which a fudden inflammation of the
fauces and lungs fucceeded, not without " fears, and anxieties, about ap-
" proaching death," really underwent this change, in the fpace of three
days. And he had, to omit other things, within the cyft, three calculi of
a confiderable fize, but " the orifice of the ductus choledocus, and the whole
" of this canal, was fo far obliterated, or conftricted, that it would not air
" low the lead probe, or bodkin, to pafs, and much lefs any drops of bile."
(i) N. jo. (I) Monit. med. c. 9. f. 1.
fk) Vid. in adnot. a Cathar. Zeno additis (m) Tom. 8. obf. 30.
vitamhujus Mauroceni abNic. Craflb fcriptam. {») Ibid, obf. 70.
4 There
256 Book III. Of Difeafes of the Belly.
There is no doubt but the cavity of this duel: was fo conftri&ed, when the
fkin was yellow,'and the inteftinal faeces " were white," and difcharg'd " (low-
" ly and difficultly." But it certainly was no longer in that conflicted ftate,
at the time when the fkin was reftorM '' to a quite natural and florid colour,"
and the fasces were difcharg'd " in a great quantity, and ting'd as they natu-
" rally are. It may, therefore, feem not abfurd to fuppofe that a fpafmodic
conftriction, which a quiet ftate of the mind, and a proper regimen of cure,
had lately relax'd, return'd, within thofe three days, from new, commotions
of that kind, together with the whole train of deadly fymptoms.
But be this as it will, if you, in the mean time, acknowledge what I have
faid of crifpatures, which are brought on by a fpafm, in confequence of cer-
tain paffions of the mind, or excited by irritations, and pains, of various
parts (0), but particularly of thofe that are the moil near to the liver ; I
lay, if you acknowledge thefe things to agree with probability, and attend a
little to what relates to irritations, you will, doubtlefs, find out the reafon
which you afk'd of me (p), why, fuppofing calculi in the gall-bladder, the
jaundice may fometimes arife, although there be no other caufe, at the fame
time, of all thofe which I mention'd above, from whence this diforder could
be accounted for.
This was formerly allow'd by me, when I faid (q) " whether the calculi
" found by me, were not yet of that magnitude, or weight, or figure, by
" which the cyft could be much injur'd, or whether they were never driven
" into fuch a fituation, as to have in their power to obftruct the bile," it
might have been for thefe reafons, that in thofe bodies, wherein I found
them, " they had brought on no peculiar diforder, or, at lealt, none that was
" evident, and indeed not fo much as an icTteric colour."
For I did not doubt, but if the cyft were irritated, either by the magni-
tude, or the weight, or, in particular, by the figure of the calculi, and chiefly
when they are fore'd into the ftreights of the neck of the bladder, by the
bile which they thus retain therein ; and at the time when this cyft is com-
prefs'd by the ftomach, and inteftines, fore'd on ftill farther and farther, that
a fpafm may then arife, with contractions, and crifpatures, which are propa-
gated through the larger and continu'd duels of the bile, on the one hand, to
the inteftinum duodenum, and on the other, to the liver : and I did not doubt
but that the paffages being thus contracted, a jaundice might be form'd, in
the manner afterwards particularly explain'd by Hoffmann (r). Therefore
the jaundice, as it can then *only be the confequence of gall-ftones, and as
what thefe then do by irritating, may be done, at other times, by different
cauies in different fituations, and even by the paffions of the mind themfelves,
this will, therefore, not be the conftant, and proper, fign of thefe cyftic
concretions.
36. And if the jaundice is not a conftant fign, is there any other that is
perpetual, and peculiar ? I very much fear left that, which was the cafe in
the time of Fernelius (j), is alio the cafe at prefent, and will be fo, for the
future •, I mean that " no manifelt marks, by which the exiftence of thefe
" ftones may, certainly, and eafily be known," can be found out, but that
(e) Supra n. 10. (rj C. 3. iupra ad n. 15. cit. §. 19. & p. 4.
(;) N. 33. f. 12. c. 12. §. 10.
(q) Epift. anat. I. n. 50. {.<) C 5. fupra adn. 13 & 27. cit.
we
Letter XXXVII. Article 37. 257
we mud dwell upon " fufpicions" only, as we have feen of the jaundice. K
docs not, however, efcape me, that there have been celebrated men, both
among the ancients, and moderns, who have attended to thefe marks with a
very laudable induftry, and have endeavour'd to approve them to eve-
ry one.
For, in the fnft place, I fee that Coiterus (7), has publifh'd fome obi
vations of his own, of thefe calculi, with an intention " that therefrom might
" be learn'd the fymptoms, which arc the confequences of this diforder."
But thefe are redue'd to a long-continu'd jaundice, and in one, wherein even
the common canal was obdructed, to a continual vomiting of food. In re-
gard to the firft of which I have laid enough already. And in regard to the
iecond, which is likewife taken notice of by others, how often it is abfent, and
by how many, and how various caufes, befides this, it may be brought on,
is certainly manifeftto every one.
Others have fince added different lymptoms, the confideration of which I
(hall not particularly profecute, as it naturally appears, that the fame thing-
mull belaid of colic pains, and other fymptoms of that kind, which I have
already laid of vomiting. And what fhall we fay, when we fee fuch lymp-
toms advane'd, as are diametrically oppofite to each other, as for in-
itance, thofe of coftivenefs, and laxity of the inteftines ? Nor does it affect, me,
to find it aflerted in the Sepulchretum(«,), that " it is fcarcely poflible to con-
ceive" of this latter fymptom taking place: for it is very clear to me, that
when the veficle is entirely fill'd up by a calculus, all the bile mull, of courfe,
flow continually to the inteftines, and if it be acrid in any confiderable de-
gree, muff, of courfe, flimulate them pretty ftrongly. But I only remark this
circumftance, that if fometimes one, and fometimes the other, is true, which
I do not doubt, neither of them, confequently, can be the perpetual, and
peculiar fymptom, of thefe calculi.
3J. But if we omit thefe fymptoms which are common to other diforders,
and enquire what the calculus can of itfelf effect, we fhall come back nearly
to thofe things, which, as I have juft now taken notice (x), have been already
faid by me in the firft anatomical epiflle. " The calculus, of itfelf," as Boer-
haave alio fays (y), " while it remains quiet, produces no dilagreeable fymp-
" torn, except a fenfe of weight, but irritates by its bulk, its weight, and
" its roughnefs." If we transfer thefe things, which he fays of the urinary
bladder, to the gall-bladder, do you fuppofe that this calculus, which is
lighter than that of the urinary bladder, and is gradually increased, will dif-
cover itfelf to exifl by a fenfe of weight ? We mull wait a long time then,
till it, at length, acquires a greater weight. But will the fign, which we
fhall be in want of fo long, and in mod cafes always, be then, at length, fen-
fible at leafl, and plac'd beyond a doubt. It was certainly fenfible in the
noble count of whom Hildanus fpeaks (»), fince, " for many years, as often as
" he turn'd himfelf from one fide to the other in bed, he could perceive a
" great, and troublefome weight, oppofite to the liver, that fell from one
" fide to the other."
(t) Obf. anat. (y) PrxlcS. ad inilit §. 790.
(u) L. 3. f. 10. additam. in fchol. ad obf. 1. (zj Obf. fupra tit. ad n. zz.
r>; n. 3s-
. Vol. II. L 1 But
258 Book III. Of Difeafes of the Belly.
But the calculi, conrain'd in his gall-bladder, were fo large as to weio-h
eighteen drachms and a half, and that when in a dried date, for when recent
from the body, they were much heavier. But do you fuppofe thefe to
have been heavier than that great number of calculi, which were found, atone
time, by Greifelius (a\ all of which, taken together, weigh'd thirty drachms ?
For he has not remark'd that the man, in whofe body he found them, had
ever perceiv!d any weight therefrom.
Yet perhaps you will fay, that the vaft quantity of fat, which was found
in his belly, might poffibly obtund this feniation. Were all the bodies ex-
tremely fat then, in which thefe calculi have been found to a considerable
weight ? At leaft the woman (£), in whom the calculi were equal to the weight
of twenty-four drachms, does not feem to have been very fat, nor yet the
pried (c), whofe calculi weigh'd twenty drachms, nor the iiluflrious man (d),
in whom they weigh'd almoft as much. Yet we read of none of thefe, what
Hildanus afferts of the count, when he turn'd himfelf in bed, nor do I ever
remember to have read the fame of any perfon, whofe gall-bladder was loaded
with calculi. To this cafe of the count, I mould fuppofe, from comparing
the times together, Stieberus (e) refer'd, when to an obfervation of that kind,
he objected another " of more than two hundred ftones," in the gall-blad-
der of a man, " who had never made any complaint of an opprefiive pain
" in the right fide."
But fuppofe that many have complain'd of that fame fenfation, of which the
count above- mention'd complain'd. Yet at the fame time call to mind thofe fac-
culi, which hung from the liver, and were loaded with calculi (/), or call to mind
even the gall-bladder itfelf, which has been found more than once to be di-
ftended with a large quantity of thick bile, to a furprizing degree. You will,
by this reflexion, clearly perceive, that the fame feniation may fometimes arife
from other caufes, befides calculi, or if it arifes from calculi, not only from
thofe which the gall-bladder contains. And "it is manifeft from thefe, and
other examples, that even the diftention, which not only the patient, but the
phyfician, alfo, by applying his hand to the part, perceives, and, confe-
quently, the effect of the bulk of calculi, affords but an ambiguous mark of
their exiflence.
The roughnefs remains. Of which I fay firft, as I have already faid of the
weight, and might have faid of the bulk, that it is not always fuch as can
irritate, and difcover itfelf by irritation. And, in thefecond place, I fay, that
even when it is of fuch a kind, the veficle is, at one time, defended by the
quantity, and at another time by the thicknefs of the bile, from the irritation
it has a tendency to create ; for that happens very rarely here, which hap-
pens almoft always in the urinary bladder, that all the contain'd humour be-
ing difcharg'd, nothing remains but the calculus, by which the bladder is
prick'd, and ftimulated, efpecially as the gall-bladder cannot contract: itfelf
like the other, and clofely embrace the ftone : and although this could hap-
(a) Obf. fupracit. ad 11. 19. (e) Sepulchr. 1. 3. f. 17. obf. 14. §. 3. cum
(b) Eph. n. c. dec. 3. a 7 & 8. obf. 123. fchol.
(c) Aft. n. c. torn. 5. obf. 129. (y) Vid. fupra n. 13.
(J) Commerc. litter, a. 1742. hebd. 28.
n. 1.
pen,
Letter XXXVII. Article 38. 259
pfcn, yet the fcnle of both bladders does not ftem equally exquifkc j and this
I lay, lell you fhould have recourfe to the turgefcency of the ftomach, and
inteftines, which, however, does not always fubfift, in order to make us
conceive how the cyit may be prefs'd clofe upon the calculus.
Finally, 1 fay that in thefe very villera, in the part where they can prefs
upon the contiguous veficle, that fame fcnle of pricking may happen to exilt
from another caufe, which would be, in the gall-bladder, from a calculus ;
and even that it may be in this veficle itfelf, from the very acrid quality of
retained bile, or from fome fpafm ; fo that irritations may be either fuppos'd
to exill in this receptacle, which are not there, or thofe which are there, may
arife from a caufe quite different from calculi.
38. What I have faid on both fides of the queftion then, hitherto, goes fo
far as to give you to understand, that there is no perpetual, no peculiar, (ign
of thefe calculi. But left you fhould chance to fufpect, that there may be
fome fallacy in reafoning, as there often is, let us confine ourfelves to expe-
rience. I let afide all my own obfervations, and thofe of Valfalva (g), in
none of which there was any fign of thofe calculi, that we, neverthelefs, found
in the gall-bladder. I alfo fet afide thofe which I have produe'd in a former
work (7^, from Gerbefius, and Lofpicklerus, who affcrt of men troubled
with calculi of the gall-bladder, " that they had liv'd a long time in health,
" and had been free from complaints."
But if others teftify the fame thing befides, is it but juft that you fhould
call to mind, all thofe obfervations which we now fet afide. Rolfinc (i), there-
fore, a phyfician of great eminence in his times, when he defcribes what kind,
of calculi he found in the cyft, fays, in general, " that ftones of the gall-
" bladder very often lie latent in that cyft, for fome years, without doing any
" injury, fometimes bringing on pain, and fometimes being without. L'E-
mery the father (£), affirms it to be well known, that thefe ftortes not only do
not caufe death, but even " frequently caufe no inconvenience whatever."
And I have already faid above (/), that Vaterus had obferv'd in a woman,
who had thirty of them in the gall-bladder, a long-continu'd, and " perfect
" health," even to the end of her life.
Galeati (w), in like manner, affirms, that in a woman, whofe body he dif-
fered, " nothing had happen'd, either in the difeafe whereof fhe died,"
(which was a dropfy) " nor before that time, as far as he could learn, that
" fhow'd the gall-bladder to be affected •," yet in this veficle, neverthelefs,
were four calculi, the largeft of which " being angular, had obftrufted the ori-
" fice of the cyftic canal." Themelius (»), alfo, when he takes notice of" fome
" biliary calculi, worthy of remark," that were found by him, in the cyft of
a ftrumpet, exprefsly fays, " that they had not been attended with any injury
" to health."
Finally, Roncallus (0), for I am not willing to mention any more here,
than naturally occur to me as I write ; gives an account of feven calculi, of
(g) Vid. fupra n. 27. (I) N. 32.
\b) Epift. anat. 1. n. 51. («) Cit. fupra ad n. 21.
(/') Diflert. de gutta fer. corollar. 4. (») Aft. n. c. torn. 5. obf. 10. prop. fin.
\k) Hift. de l'acad. r. des fc. a. 1703. obf. (0) In epift. addit. ad hift. morbor.
ar.at. 1.
L 1 2 the
260 Book III. Of Difeafes of the Belly.
the fize of a fmall walnut, being found, by him, in the gall-bladder of a wo-
man, who died in the eighth month of her pregnancy, and who, in the whole
of that time, and long before, " had been endow'd with a very good habit
" of body, was well nourifh'd, and had a good colour ■''' fo that it was ma-
nifest, unlefs thefe concretions had been form'd in an inftant of time, which
cannot be fuppos'd, " that health may continue," even when thefe are pre-
fent.
If am not by any means deceiv'd then, it is furHciently demonftrated, that
there is no perpetual fign of cyftic calculi, and, confequently, that there is
none proper, and peculiar.
39. How is it then, you will fay, that Wepfer (/>), a very experiene'd
phyfician, has written thefe things to Verzafcha : " I do not think that the
" neck of the gall-bladder is ftop'd up, becaufe there is not the leaft
" complaint of a cardialgia, or pain with tenfion, near to thecartilago enfifor-
" mis, the feat of which might be cover'd with a filver penny ?" Did not he,
at lead, think this an infeparable fign, where the calculus had ftop'd up the
neck of the gall-bladder ?
But I would have you attend to this, that he has not made mention of
calculi in particular, and that there are other caufes befides a calculus (#),
which are capable of obftructing the cyftic duel:, as well as the other biliary
ducts. And in the fecond place, even when a calculus obftructed this duct,
Galeati, as was juft now laid, did not only not obferve a jaundice, which
alone was found to be abfent, at that time, by Bezoldus(rJ, and wasprov'd to
be fo, in many cafes, by Pechlinus (j), but even remark'd that nothing was
the confequence of it which could fhow the cyft to be affected : and the fame
remarks, nearly, were made by Reverhorft (/) : and by Phil. Jac. Hart-
mann (u), in two bodies : nor has Haller (x) any thing contradictory thereto,
in the diffection of three bodies: nor, finally, he who could have related with
accuracy all the fymptoms of a patient, I mean the celebrated Trew (y).
And although Tacconus (z) lays, that very great pains, in the hypogaftric
region, had been join'd with a quartan fever, yet he not only fays, that the
iaundice had not attended, at the fame time, but even that there had not
been thofe pains which reach to the cartilago enfiformis, as he had exprelsly
fignified, in another woman, a little before, where he fuppos'd the exiitence
of calculi, in the ductus communis. You fee therefore, that not even when
the meatus cyfticus is obftructed by a calculus, as it was in all the bodies I
have refer'd to, is that pain, which has been defcrib'd by Wepfer, a conftant
and perpetual fign of its exiitence.
40. And although our original enquiry, here, was after the fymptoms of a
calculus, not only when thruft down into thatpalTage, but, in general, when
exifting in the gall-bladder, yet it will not repent me, that I have examin'd
whether the fign defcrib'd by Wepfer, be proper to a calculus, that is fallen
(p) Sepulchr. 1. 3. f. 17. in fchol. ad obf. 6. (t) Difl". dc mot. bil. §. 57.
in additam. (a) Eph. n. c. dec. 2. a. 5. obf. 72 & 77.
(7) Vid. fupra n. 33 & 34. (x) Opufc. pathol. obf. 33. hift. 4. 13. 14.
(>■) Difl". de colelitho caf. 1. n. 6. (_y) Commerc. litter, a. 1743. hebd. 32. n. 3.
(;) Vid. att. erud. Lipf. a. 1691. m. maj. in (s) Cit. fupra ad n. 16.
recenf. 1. ejus i. obf. 58.
down
Letter XXXVII. Article 41. 261
down into the ductus communis, fince it cannot be proper to that which re-
mains in the veficle, as was fufficiently demonftrated above (rfj, when I treat-
ed (lightly of the fenfe of diftention. For as to an.oblervation occurring in
the Sepulchretum (b), to which this title is prefix'd, " a pain about the car-
" tilago enfiformis, from calculi in the ftomach, and gall-bladder ■," take care
how you fuppofe that the obfervation correfponds with the title : lor in read-
ier the cafe, you will find, indeed, that many calculi adher'd very
cloilly to the fundus, and fubftance, of the ftomach -, but that there was any
calculus in the gall-bladder, or in any other part, you will not find.
From this obfervation, therefore, you will rather learn, that it was not a.
proper fymptom of calculi exifting in the ductus communis, which fhow'd
calculi to be adhering to the ftomach. And, indeed, it befides thtle, others
had alio exifted in the ductus communis, yet there would be room for doubt,
to which of theie two kinds, this pain ought to be afcrib'd, juft as when in
a hiftory of the fame kind of pain, calculi are defcrib'd in that duct, and the li-
ver is laid, at the fame time, to be almoft full of deprav'd matter, and to
have very confulerable diforders, and in another, many tumours are laid to
have exifted throughout the liver, and this meatus to have been much com-
prefs'd by one of them : although, if the compreflion, or obftruction, of the
duftus communis be fuppos'd, of itfelf, to bring on the caufe of that pain,^
whereof I fpeak •, it, of courfe, cannot be confider'd as the peculiar mark
of ftones fticking therein, as it is fufRciently fhewn above (c), that this canal,
may be both comprefs'd, and obftrufted, without calculi, and as nothing for-
bids us to imagine, that bile may be fometimes confin'd therein, in a very great
quantity, and that it is fometimes naturally fo acrid, or becomes fo by ftag-
nation, that it has a power to diftend, and to ftimulate, the canal in the fame
manner with calculi.
Do not imagine, however, that the induftry and fkill of thofe who en-
quire after truth, and endeavour to increafe medical knowledge, are lefs
efteem'd by me, than by the celebrated man, who proves the explication of
the pain in queftion, by the firm connection of the ligamentum fufpenforium
of the liver, to the peritonaeum, where it covers the enfiform cartilage :
but influenc'd by the fame love of, and defire after, truth, that influence me
at prefent, he foon after fubjoins the following words : " and not in calculous
" affections of the liver only, but in inflammations, or other tumours of the
" lame vifcus, which have their feats not far from the roots of this ligament,
" thefe things are proper to explain the various fymptoms of this kind, that
" arife from thence, and, particularly, the pain of the cartilago mucronata,
" of which we fpeak, and which, in fimilar circumftances, is frequently
" found to attend inflammations of the liver."
41. And this fymptom is not only common to other diforders that are
taken notice of, whether they be feated on the outfide of the liver, or within
the liver, or in the dudtus communis itfelf, but does not always occur, even
at the time when there are ftcnes in this duct. For all biliary calculi, what-
ever, that are difcharg'd from the inteftines, mult-, of neceflity, have pafs'd
through the ftreights of this duct to the inteftines : and yet, notwithftanding
(«) N. 37. (f) N. 10 & 34.
(b) L. 3.f.7.obf. 32.
fo.
262 Book III. Of Difcaies of the Belly.
fo many obfervatkms are extant, of (tones of this kind being difcharg'd with
the (tools, how few are there in which we read, that a pain at the cartilago
cnfiiormis had preceded the diicharge ?
It does not, however, efcape me, that all the (tones, thus difcharg'd, are
not to be fuppos'd to have come from the liver. And, indeed, I readily con-
fefs, that although from the time in which they firft began to be cblerv'd,
which was before Galen (d)y to this very time, almoft innumerable obferva-
tions of thefe concretions have been collected by Dpnatus (e), by Schenck (f),
by Rhodius(^), by Schrockius the father (h), and by others, it feems to me
that many of them have been generated in the inteftines, or the (tomach,
itfelf.
For that they may, alfo, be generated in the (tomach, ancient examples
prove, the firft of which is related by Donatus (/), when my fellow-citizen.
"' Mr. Jo. Juliani, of Forli, lent a (tone to Gentilis, which was thrown up
" by vomiting, equal to the fize of a nut, after a pain of the (tomach, which
" in its hardnefs exceeded that of gypfum, and was, in its (hape, like that of
tc an egg:" and one fimilar to this, except that it did not exceed the fize of
a jubeb, was of a whitim colour, and not furnifn'd with evident (trata, I
formerly faw in the place of my nativity, which a woman had thrown up by
vomiting, in like manner, after long-continu'd pains of the (tomach.
But though others have lately thought that they have prov'd them to be
generated in the inteftines, by examples which, perhaps, are not very pro-
per for the purpofe, to me that feems more fuitable to the prefent occafion,
which you will find in Ballonius (k), " of a (tone in the inteftines, which was
M perforated fo as to fuffer the more liquid matter to pafs through it-," for it
feems to have been form'd, by degrees, of earthy, and vifcid, particles adher-
ing, round about, to the inteftines : the other particles pafling through the
middle of it, and keeping the paflage open.
Who will venture to deny, that (tones which are the largeft of all, and
nniverfally made up of one, and the fame, matter of this kind, had not their
firft beginning in the inteftines, as they certainly had their increafe ? And
indeed although I read that fome were of fuch a kind, either in their mag-
nitude, or colour, or their figure, that any one might eafily refer them to
the clafs of cyftic concretions, as, for inftance (/), thofe which were " at one
" time fmaller, and at another time larger, than peas," or " than filberts,
" thofe which were of a yellow colour," or *' in great part yellow," thofe
which were " triangular," or otherwife " angular ;" and, finally, to comprehend
many examples in one, " thofe which in their (hape, colour, and magnitude,
" were like to the feeds of melons j" yet I will readily omit all thefe, efpe-
cially as the fymptoms which had preceded, are either not related with the
neceflary accuracy, or not related at all.
I will go on to thofe which the authors who defcribe them, or other men
of eminence, have confider'd, and not without reafon, as cyftic, or, at leait,
{d) Vid. apud Schenck. obf. med. 1. 3. ubi (h) Obf. fupra ad n. 24. cit.
de inteflin. lapid. obf. 1. (/) Cap. modo cit.
(e) Cap. fupra ad n. 15. cit. (A) L. 2. confil. med. 24.
(f) Obf. 1. modo cit. (/) Vid. apud Schenck. obf. 1. modo cit.
(g) Cent, 2. obf. med. 74.
biliary
Letter XXXVII. Article 42. 263
biliary concretions. But Fernelius, whom I have mention'd in a former
work(w), fays no more than that he had found " alter a long jaundice, iuc-
" ceeded by a diarrhoea, innumerable calculi of this nature, like peas, or
" barley-corns, to be dilcharg'd by molt pcrfons." Coiterus, in like man-
mer (»), fays that he knew a woman, " who was fixed from a very trouble-
" fome, and long-continu'd jaundice, by a difcharge of a calculus with lui
" {tools. " That Solomon Alberti, " had often obferv'd calculi to be dip
" charg'd with the faces, altera very long jaundice," I know very well from
the celebrated Ilaller (o) : but whether he laid more than this I know not,
inafmuch as I have not his lecond " oration," which he there quotes-, not that
which is among the three publifh'd in the year 1585, but that which is with
the four publifh'd in 1590, for that that is what he refers to, I do not doubt,
as I fee it is entitled in Linden (j>), de felle ad intejlina rcftcg'iicnte, &c.
I have faid above (*), that Malpighi has aflerted a (tone to be dilcharg'd by
a matron, *' after great pains and a long jaundice." That Ruyfch (q) pre-
ferv'd " a calculus, which came from the gall-bladder, and was dilcharg'd
"per a?iuw" I have read, but not what fymptoms had preceded the dif-
charge. And others I purpofely omit, who have either faid no more than
Ruyfch, of what had preceded, or have not mention'd fo many fymptoms as
Malpighi.
42. It is better, therefore, to pafs over to thole who have made mention of
the feat of the pain which preceded. Hoffmann the father, as the fon re-
lates (r), has faid that there had been " very acute pains of the right hypo-
" chondrium." Dillenius (s), that after pains which had, " for a very long
" time," occupied the fame hypochondrium, " colico-nephritic pains had
" fucceeded." Bartholin (/), from the obfervation of Tinctorius, " that
M there had been many complaints of a pain in the right fide, which ex-
" tended to the inteftines." Lentilius («), " a very great pain about the re-
" gion of the liver, with a tumour ; of which pain, however, the patient had
" already complain'd, for the fpace of ten years." Wolfstrigelius (x), who
has fpoken more fully on the fubject than the others, that pains had, at feve-
veral times, preceded, " which refembled colico-nephritic pains, and which,
" though they frequently grew milder, yet as often return'd with violence;"
that upon a relapfe into this difeafe, as frequently happens, " there was a pain
" of the loins, and a rending pain about the right hypochondrium, at the
" place where the ductus choledocus is inferted into the duodenum :" that the
difeafe returning again, " there was a pain which, indeed, rather refembled
" a colic pain, as it was not felt about the loins, and right hypochondrium,
" but chiefly towards the navel."
In fine, our Valiineri fjy), who profecuted every inquiry, himfelf, with ac-
curacy, having obferv'd fimilar cafes, firft in the place of his nativity, and
after that here at Padua alfo, has faid nothing [more in regard to pains, than
(m) Adverf. 3. animad. 28. (r) Medic, rat. t. 4. p. 2. f. 2. c. 3. in fin.
(n) Obf. anat. (s) Eph. n. c. dec. 3. a. 9. obf. 246.
(0) Ad Boerhaav. praeleft. §. 348. not. (m). (t) Cent. 4. hift. anat. 49.
(/) Renovat. de fcript. med. 1. 1. («) Eph. n. c. dec. 2^. 7. obf. 136,
(') N. 23. (x) Earund. dec. 1. a. 2. obf. 89.
(f) Prajf. ad thef. animal. 1. (y) Epift. fupra ad n. 13. cit.
" that
264 Book III. Of Difeafes of the Belly.
*' that they hail been very violent in the region of the liver, and had ex-
" tended themfelves towards the navel." The cafes propos'd by Vaterus (z),
and (till more by Bezoldus (a), I purpofely pafs over, on account of the mag-
nitude of the calculi, which, though they certainly had their beginning in the
gall-bladder, yet, as they might feem to have receiv'd their increafe in the
inteftines, fhould have been then faid to have come from thence, rather than
from the common biliary canal. And Vaterus fays that there had been " ve-
" ry violent, and excruciating pains of the belly, which firft occupied the
" region of the navel, and at length fettled in the lumbar region." And
Bezoldus, that after the patients " having been furprizingly harrafs'd for fix
" years and more, with pains of the right hypochondrium," a flone was
at length difcharg'd by the inteftines, but " not without griping pains." You
fee then, that in all thefe obfervations, no pain is taken notice of, which had
its feat about the enfiform cartilage.
Noi is any thing hinted in regard to fuch a pain, by the two Hoffmanns,
Maurice, and Frederic. For the former (£), though it is true he mentions
4i the anterior parts," yet mentions them in fuch a manner, as to fay that
there had been " a long-continu'd vellicating pain, with tenfion, under the right
** hypochondrium, which was troublefome towards the anterior parts." And
although the latter (c)> befides " an intolerable pain in the right fide, and un-
" der the falfe ribs," adds the following words •, " about the fcrobiculus cor-
" dis was a violent oppreffive pain, which even extended itielf into the um-
" bilical region ;" yet the fcrobiculus cordis does not comprehend the. enfi-
form cartilage, or if you would have it comprehended in thefe words, you
mufb then call to mind, that in this obfervation, the queftion is not of a
" calculus," but of " bilious fordes (topping up the ductus choledocus •," fo
that by this means thofe things might rather be confirm'd, which I have ad-
vane'd above (d), in regard to the ambiguity that mud be the confequence
of this fymptom, which is certainly, alio, the confequence of other fymp-
toms, in the next obfervation of Hoffmann (e).
However, in the laft (f), where the queftion is of calculi obftructing that
duct, he mentions " an acute, and almoft intolerable pain, deeply fix'd in the
" region of the liver, with pains of the inteftines, which were troublefome
4fc now and then, and remitted at intervals." Finally, turn to thofe things
that are written by the very fkilful archiater Van Swieten (g)t where he tells
us what he has obierv'd to happen at this time ; you will find not a word of
pain at the enfiform cartilage. And as upon duly confidering all the obfer-
vations that I have produe'd, you will obferve that the pain was never ex-
tended to that cartilage, but to the navel, or the umbilical region, more
than once, if you fhould happen to prefer taking the explication, not from
the inteftinum jejunum, into which the duodenum is continu'd, but from
that part of the ligamentum fufpenforium of the liver which is better known
to Euftachius (b), than to Reverhorft (i), and accompanies the umbilical
(x) Difiert. qua obf. rariff. calcul. obf. 3. (t) C. cod. 3. obf. 5.
{a) Diff. decolelitho caf. 2. (f) Ibid. obf. 6.
(6) Eph. n. c. dec. if a. 7. cbfer. 244. (g) Comment, fupra ad n. 15. cit. §. 950.
(.-) Paulo ante cit. capite 3. obf. 4. (i) Tab. anat. 2. fig. 3 & 4.
(J) N. 40. ^;) Difl". demotu bilis. fig. 1.
4 ligament,
Letter XXXVII. Article 43. 265
ligament, or even from this ligament itfclf, you are at the fame freedom to
do it for me, as from the other part of the ligamentum fuiperiforium, when
the pain fhall, at any time, extend itlelf to the enfiform cartilage, as has been
oblerv'd by others.
43. If, therefore, biliary calculi, as has been demonftrated hitherto, and
will be confirm'd patently (k)y do not difcover themfelves, by any conftant,
and peculiar fymptoms, even when they are fo far from being in a ftate f
reft, that they are endeavouring to procure a difcharge for themfelves, how
much lefs will they be able to do that, when they are in a perfect (late of
reft, in their veficle ?
But you will fay that the fymptoms of calculi, inherent in the kidnies, and
urinary bladder, alio, are very frequently ambiguous, and yet not held in
contempt by phyficians, info great an obfeurity of things. Nor do I de-
fpife the fymptoms that have been advane'd, as marks of the exiftence of cy-
itic calculi -, but I complain (/) that they are more proper to make us fufpect
their exiftence, than to convince us that they actually do exift. Yet if we are
to infill upon fufpicions, I not only commend thole who endeavour to add
fome weight to thefe fufpicions, by increafing the number of the fymptoms,
bur, amongft them, I alio take the liberty to mention myfelf.
Therefore, although I know that ftones of thecyft are not always join'd with
bile, which refemblcs fordes, nor always with urinary calculi, yet I believe that
the lufpicion of Sylvius, which you even have in the Sepulchretum (*»), is
not altogether to be defpis'd, who fears left thofe that vomit bile of this kind,
fhould have concretions in the gall-bladder ; and that another fufpicion of my
own ought not to be concealed. For I having, befides thofe that I formerly
mention'd (;;), as feen by me, feen others alio, and read of others, that have
been fiibject to bilious, and urinary calculi, at the fame time : and as in turn-
ing over the obfervations, which I have in part made ufe of in this letter, I
met with a great number likewife ; I eafily perceiv'd that thefe things did
not happen by chance. Of thofe who I have read were thus affected, I will
not omit one, who deferves to be taken notice of, in preference to the reft,
on account of his merits in the medical faculty, I mean Michael Mercati (o).
This gentleman having died of nephritic tortures, and having two ftones, of
a considerable fize, flicking in his ureters, and in his kidnies fixty-three,
which were all pretty fmall, or fome of them only, as his preceptor Csefal-
pinus has written, large, had, alfo, in his gall-bladder (although, as they
take notice, he had never been attack'd with the jaundice) fix and thirty of
an obfeure colour, angular in their figure, and of the bignefs of a vetch.
And who is there, that ; reading thefe things of Mercati, and in that
great number of obfervations moreover, that the bifhop, mention'd by Las-
lius a Fonte (/>), ifas wont frequently to labour under the ftone of the
kidnies, that the count of Hoechftetter (q) had a ftone, and fabulous
formations therein, that the cooper of Wepfer (r) had a fmall ftone,
(k) N. 44. & feq. (0) Vid. ejus vitam & teftimonia, metallo-
(l) Vid. n. 36. thecae ejufd. Vaticanae praefixa.
(m) L. 3. f. iS.obf. 9. (j>) Conf. cit. fupra ad n. 31.
(>/) Epilt. anat. I. n. 48. (?) Caf. cit. fupra ad n. 17.
(>■) Hilt. cit. fupra ad n. 20.
Vol. II. Mm in
266 Book III. Of the Difeafes of the Belly.
in a papillary caruncle of one kidney, that the woman of Borrichius (s) had
difcharg'd calculi from both bladders, that another of Morton ft) had one
kidney rrll'd therewith, that the old man of Reverhorft {u) had the fame
in his kidnies, and urinary bladder-, will not fufpect the caufes to be fimilar ?
And left you fhould be inclin'd to fuppofe that this happen'd only in old
perfons, take notice, I beg of you, that a virgin of eighteen years of age,
fpoken of by Bonetus (x), had a (tone taken from her by the lithotomift, of
the bignefs of a goofe's egg : add to this that Bergerus (y) had found calculi
in both the bladders of a counfellor at law •, Lancifi fz), alio, in the kidney
of that excellent man Horatio Albani, both a large ftone, and many fmall ones •,
and, finally, that Hoffmann (a) found one, which was not fmall in its fize, in
the kidney of a gentleman, and one much larger in the urinary bladder.
For I fhall, defignedly, take no notice of a great number of other authors,
and among thefe Jo. Bapt. Contulus (b), Chriftophor. Cunradus [c), Vitus
Riedlinus (d), Tob. Ferd. Pauli (e), Jo. Cafpar. Grimmiusf/J, Jo. Sebaftian
Albrechtus (g)t Jo. Jacob. Trelyngius (h), Chriftoph. Jac. Trew (/), who
obferv'd the fame in two bodies, Jo. Storck (k), and Ifr. Cregutus (/) : thefe,
I fay, and others (»), 1 fhall omit •, fince befides Baglivi (k), who fo far confi-
ders this as what generally happens, that he has enquir'd into the reafon,
" why, when there are calculi in the gall-bladder, they alio are generated in
" the urinary bladder, and vice verfa," the teftimony of Abraham Vater
alone (o) may pafs for many, who exprefsly affirms, " that calculi have,
" beyond a doubt, been very frequently obferv'd in the gall-bladder, in thofe
" who have, at the fame time, labour'd under a calculus of the urinary
" paffages."
Who then can read fuch teftimonies, and attend to fo many fimilar cafes,
without immediately conceiving with Vaterus, " that the caufes" of both fpe-
cies of calculi are, in a great meafure, " evidently common to each other ?"
And if you take this for granted, you will, doubtlefs, begin to think with
me, that when to the other marks of bilious calculi, this alfo fhall be added,
that the patient is fubjecl: to calculi of the urinary paffages, fome weight will
be given to the other fufpicions ; efpecially if, according to what has been ob-
ferv'd above (/>), this patient is neither an infant, nor a child, but is already
in a middle age, or advanc'd in life : which remark, drawn from the age of
the patient, may, if join'dwith others, help us to diftinguifh inteftinal calculi,
that have been difcharg'd by ftool, from fuch as are generated in the liver.
Thus the celebrated Carlius (<?), when he had not believ'd that a certain
(s) Yid. Bartholin. a6t. Hafn. vol. 5. obf. (g) Eorund. t. 4. obf. 49,
65. (h) Eorund. t. 5. obf. j 29.
(t) Phthifiolog. 1. 3. c. 14. hift. ;. (/') Commerc. litte^ a. 1734. hebd. 6. n. 5.
(«) Did", fupra ad n. 42. cit. §. 56. & a. 1743. hebd. 32. n. 3.
[x) Sepulchr. 1. 2. f. 4. obf. 35. («) Commerc. litter, a. 1735. hebd. 52. n.4.
( v) Phyfiolog. 1. i.e. 14. (/) Differt. de calc. in corp. hum. generate
(jg) Oper. torn. 2. difi". 10. &C. §.31. in fin.
(«) Cap. 3. fupra ad n. 42. cit. obf. I. (m) Vid. epift. 57. n. 12.
(£) Dclapid. c. 25. (n) De experim. circa bilem.
(r) Eph. n. c. dec. 3. a. 9 & 10. in obf, 171. (0) DifT. cit. fupra ad n. 16. thef. S.
(d) Earund. cent. 3. obf. 45. (/) N. 15.
[e) Earund. cent. 9. obf. 76. \q\ Cemmerc. letter, a, 1731. fpecimen. 51.
(fj A&. n. c. com. 1. obf. zo. n. i.
calculus,
Letter XXXVII. Article 44. 267
calculi]';, which was rcckon'd among cyftic calculi, and which had been dif-
charg'd among the fitces, by a boy of eighteen years of age, did really be-
long to that clafs, for this reafon "in particular, becaufe fuch an age dens
" not naturally bring on a difpolition of that kind " (and it certainly does nor,
except very rarely, which is one point, wherein bilious, ami urir ny, calculi do
not agree with each other) knew afterwards, that the liver of this young man,
who had died of a dyfentery, was found to be as found as that of the molt
*' healthy young animal can be :" whereas the calculus " of two ounces
*' and a half in weight," for fuch it was, though it might have receiv'd the
greater part of its increafe in the inteftines, would, at lealt, have left lb me trace
of its former relidence, and paffage, in the gall-bladder, and the ducts affixM
to the liver.
44. But although the marks of bilious calculi, which I have taken notice of,
are, as appears from thofe things that I have hitherto laid, as Hoffmann ad-
monifhes (r), " to be taken and confider'd collectively :" and as all thefe marks
cannot exill in all perfons, the greater part of them, at lealt, and among thefe
the principal are to be attended to (by the principal, I mean thofe which are
wont to be the more frequently obferv'd, as, for inftance, when flones de-
fcend into the ductus communis, there is certainly a pain feated on the
right fide, ajaundice, vomiting, anxiety, relapfe-, for fo I have in general ob-
ferv'd, in many of thole obfervations that are pointed out above (s) ) although,
I fay, we mull proceed in the manner I have laid, yet we ought never to for-
get, how eafily a deception may happen.
For if you compare with the greater part, or the principal of thefe marks,
thefe two obfervations of Hoffmann, which I even refer'd to before (/), you
will find that my furmifes are not without foundation. And you will per-
ceive the fame thing, when, after having faid (u) " that there are fome fymp-
*' toms which prove the exiftence of calculi, in the biliary duels, that are
*' by no means fallacious," and enumerated the chief of them, he prefent-
ly (#) produces the figns of a very large calculus, flicking in the gall-
bladder ; but efpecially, when he describes the fymptoms (y) of a jaundice,
which was not brought on by any calculus, but only by a fpafmodic
" ftricture."
Yf>r it not uncommonly happens, that as in urinary calculi, fo in biliary
alio, we have a mark of their exiftence which is much more to be depended
upon than the others ; I mean when any one of thefe concretions, or fome frag-
ment of them, at leaft, is difcharg'd. And as this very fign, which is evi-
dent even from the natural light or reafon, was mention'd by others before,
and among thefe by Vaterus (2), but particularly, and fully, by Vallifneri
(rt), it may feem very furprifing to any one, why it is omitted by Hoff-
mann, among thofe figns that are "by no means fallacious ;" efpecially
as, five years before, this very author had taught the following things (b),
(r) Cap. 3. fupra ad, n. 43. cit. §. 15. (y) Obf. 1.
(/) N. 42. CzJ DifT fupra ad n. 16. cit. thef. 12.
(/) N.eod. id. eft. obf. 4 & 5. {a) Epift. fupra ad n. 13. cit. adnot I.
(«) Ejufd. torn. 4. p. 4. c. 12. §. 11. (4) Tom. 4. paulo ante cit. p. 2. c. 3. §. 18.
W §• 17-
M m 2 " but
268 Book III. Of Difeafes of the Belly.
" but among all thefe figns, which 1 have already admonifh'd you of, there
'4 is none more certain, whereby to judge of violent affections proceeding
" from the biliary calculi, than the difcharge thereof, together with the in-
" teftinal fasces-, and then, juft as it happens, in the cafe of renal calculi,
" when they have been carried down from the ureters, into the bladder, all
M the pains, together with the other violent affections, inftandy and totally
" ceafe, and expire, at leaft if you except the jaundice, which does not im-
" mediately, but gradually difappear."
When, therefore, the figns of calculi having intruded themfelves into
the biliary ducts, and endeavouring to procure an exit for themfelves into
the inteftinum duodenum, have preceded ; if among the fasces difcharg'd from
the inteftines, which ought then to be carefully wafh'd by fervants, and, ac-
cording to the admonition of Vallifneri, pals'd through a kind of fieve, any
biliary calculus be found, it is not to be doubted, but this fign muft throw
fu'ch a light upon the cafe, as could not be hop'd from fo many other marks,
that are, at beft, but uncertain, and, in fome meafure, obfeure.
45. But there is need of caution, left we fhould happen, at any time, to
take an inteftinal calculus for a biliary one, or, that all the ambiguity of words
may be avoided here, for an hepatic calculus, that is a (tone which is gene-
rated in the canals of the liver, or its appendage the gall-bladder.
There is a certain obfervation in Hoffmann (c), of twenty ftones being dif-
charg'd by vomiting •, in regard to which, although he did not think it alto-
gether incredible, that they mould have proceeded from the biliary ducts, he,
neverthelefs, rather fuppos'd them " to have been generated from the fuccef-
five, and alternate, concretions of very vifcid, and earthy bile, in the flexure
" of the inteftinum duodenum itfelf:" for they were angular, and of a yel-
low colour inclining to green •, and of fuch a magnitude, that without ex-
cruciating pains in the right fide of the belly, none of which had preceded,
it did not feem poffible for them to have pafs'd through the ductus com-
munis.
Yet a jaundice had preceded the difcharge of thefe ftones, and " immedi-
" ately" after this difcharge, which ought to feem very aftoniflning to thofe who
attend to the exception of Hoffmann, juft now mention'd (d), " was remov'd."
If, therefore, as they prevented the paffage of the bile into the duodenum
by their obftruction, fo the bile either naturally, or by ftagnation, was made
acrid, or thefe calculi had very acute angles, you readily perceive, that not
only a jaundice, but pains in the right fide alfo, and other fymptoms that are
the confequences of them, might have been previoufly caus*d by them, and
even have been remov'd by their difcharge.
But it is rather pofiible that thefe fymptoms may be join'd together, than
frequent : and no pains of the right fide having preceded, in the obfervation
in queftion, might have render'd the phyfician fufficiently cautious. The
abfence of which, or of the jaundice, and ftill more of both, ought in like
manner to render him cautious, when calculi, which might otherwife feem
to be cyftic, are difcharg'd from the inteftines, as in thofe examples that
will be immediately pointed out. And firft, three calculi occur to my mind
(0 Ibid. obf. 2. (</; N. 44.
CO
Letter XXXVII. Article 45. 269
(e) (f) (g), that were difcharg'd in the manner I have mentionM ; of which,
whether you attend to the globular, or oval figure, to the external, or in-
ternal colour, and fome other circumflanccs, you certainly will not be for-
ward to deny that they might be cyftic calculi, particularly if you call to
mind that fotne very fimilar have been, at times, found in the gall-bladder:
yet when you read that there had been gripings and pains of the belly, but
none in the right hypochondrium, and even that, in one inftance, there
were oppreflive pains in the iliac region, you will believe that they were in-
teftinal calculi, and that lb much the more readily, as you will fee that not
a jaundice, but a volvulus, is taken notice of, in each of thele three cafes.
Three other instances fucceed. In regard to the firft of which (b), if it
made any mention of the jaundice, and did not fay that the (tones were dif-
charg'd " without any pains," their description would lo much the more in-
cline us to take them for cyftic calculi •, as, in their fize, they were by no
means to be compar'd with thofe that are mention'd in the three former, and
in as many fubfequent, examples. The fecond of thefe (i) mentions colic
pains indeed ; but not in the right hypochondrium, nor join'd with a jaun-
dice. For which reafon I fhould more readily fuppofe, with the obferver
of this inftance, that the calculus, although furnifh'd with concentric fhells,
as the figure fhows, and internally, and externally, yellow, had been gene-
rated in fome interline, pretty near to the entrance of the bile.
So in the third example (&), I agree with the celebrated Albrechtus, who
fuppofes the calculi to have been form'd in the inteftinum colon ; which cal-
culi he, neverthelefs, defcribes, of a triangular figure, fwimming in water,
and inflammable : I agree, I fay, not lb much becaufe they contain'd, under
an obfeure external yellownefs, a very white matter which was, however, folid,
" like pretty hard foap," as becaufe a violent pain was not wanting in the
right hypochondrium. But, to take no notice of" the odour of impure lard,"
which proceeded from them in burning, and other circumftances, I do not
fee that any thing is any where obferv'd in relation to the jaundice.
Finally, out of the four examples which I, at prefent, chufe to add, if the
calculus which is fo (lightly mention'd by the celebrated God. Guil. Muller
(I), as to call it " bilious" and to reprefent it as being form'd of itrata,
which inclos'd each other, could have been defcrib'd more fully, and we
could have known with what previous, or concomitant, fymptoms it had
been difcharg'd, perhaps I fhould admit it without any doubt : as I do cer-
tainly admit thofe, that the celebrated Jo. Phil. Burggrave (m) defcribes, as
being difcharg'd after violent, and thofe returning, pains of the right hypo-
chondrium, not without an icteric colour, both in the face and in the urine.
And fome that were feen by the celebrated Brunnerus (n), although they
were without a jaundice, we muft, of courfe, admit for this reafon, becaufe
by diffection, he found them already begun in the liver.
That is to fay, a man having been troubled, almoft ten years, with a con-
(e) Commerc. litter, a. 1740. hebd. 19.11. 2. (A) Eorund. t. 3. obf. 57.
(f) Eph. n. c. dec. 3. a. 3. obf. 21. (I) Eorund. t. 6. obf. 09. circa medium.
(g) Aft. n. c. torn. 7. obf. 100. (m) Eorund. t. 5. obf. 78.
(/>) Eorund. t. 3. obf. 82. (») Commerc. litter, a. 1738. hebd. 18. n. 1.
(»') Eorund. t. 8. obf. 121.
ftant
270 Book III. Of Difeafes of the Belly.
ftant pain of the belly, and particularly of the right hypochondrium, which
at firft was heavy, and obtufe, though attended with tenfion, but afterwards,
at times, became acute, and, at length, very fevere, nor chang'd its fituation
from the right hypochondrium, fo as to be at laft intolerable, difcharg'd
light, and yellow calculi, which were of a lameliated ftruclure, and angular
in their figure. This man dying after three days, had in his gall-bladder, which
was enlarg'd, a mafsof a dark red colour, inclining to blue, and green, and
foft in its confiftence-, and in the middle of the cyftic dud, and in the com-
mon duel, where it opens obliquely into the inteftinum duodenum, a matter
adher'd, which was fomewhat lefs foft indeed, but, neverthelefs, form'd by
thofe duds, into two " oblong and rounded" globules : finally, in the colon
were found fifteen calculi compacted into one globe, but eafily feparable, and
not yet fo hard as thofe which had been difcharg'd by (tool.
It could not, therefore, be denied that thefe had been begun in the biliary
duels ; and that having become, by degrees, lefs foft, they were, at length,
harden'd by their abode in the inteftines. And it " through the whole of
" the difeafe, no fign of a jaundice manifefted itfelf," either fuppole that
the matter was certainly more foft in the living body, than on the third day
after death, when it was found in the duels •, and that therefore it not al-
together obftrucled the diicharge of the bile, and had, perhaps, created
pains by its acrimony, more than by its obftruclion : or call to mind thofe
things which I have hinted above (o), in a fingular cafe of this kind, in order
to conceive, that even when the common duel is obftrucled, a jaundice may
ibmetimes be abfent. And in confideration of this it was, I juft now faid
that the abfence of the jaundice, but (till more the abfence of both jaundice,
and pain, on the right fide, ought to render the phyfician cautious, and
make him attend to all the other fymptoms, united, before he pronounces
any thing.
Wherefore, to fubjoin the fourth example, I fhall not very readily exclude
from the number of hepatic calculi, thofe which Fr. Slare (/>) faw, and which
were difcharg'd by a noble woman, " who had been very much excruciated with
" hepatic pains," at two different times, and in a few hours after the pain :
for although in writing the cafe with brevity, as frequently happens, he has,
perhaps, omitted what related to the jaundice, yet he has not omitted the
odour of the calculi (that is when burnt) their colour, their tafte, agreeing
with that of bile, and befides thefe their lightnefs in water, and their inflam-
mability. And I could wifh that thefe two laft-mention'd marks were either
never at all obferv'd in inteftinal calculi, or at leaft always in hepatic ; it
would certainly be much more eafy for phyficians to take care, left the one,
as Matthiolus formerly fear'd (<?), fhould be taken for the other.'
But it has been fhown, that thofe two figns, which mod phyficians made
ufe of, with Reverhorft (r), are frequently fallacious. And if Vailifneri
admonifh'd us to beware (j), left any calculi fhould be halt.ly thrown out
from the number of hepatic calculi, for this reafon, becauie they neither
(0) N. 34. (?) L. 5. epift. med. 3.
(/) Vid. commerc. litt. a. 1735. hebd. 5.111 (r) Vid. fupra n. 25. 26.
adnot. ad n. :. (s) Adnot. 1. cit. fupra ad n. 44.
fwam
Letter XXXVII. Article 46.
271
fwam in water, nor were inflammable ; and this at a time when wc had begun
to weaken the credit or their iigns, by a very few experiments only ; how
much more does it behove us to beware at prcfent, when the experiments
have multiplied upon us, to llich a degree, that it does not Teem poflible to
reduce the exceptions to any certain heads (().
And how much cyftic calculi may vary, not only in colour, and form, but
even in the very exu rnal, and internal flructure, and in the mode of their
fubllance likewife, lb as to be even Come times pellucid, has been accurately
remark'd above (/<) •, lett if any fhould, at times, occur, which differ in iome
refpects, or even conlkl. rably, from the common appearance of biliary cal-
culi, you immediately pronounce that they are not hepatic •, and that you may
previoufly, and particularly, confidcr the other properties, and well weigh all
the fymptoms, which have preceded, accompanied, or been the confequents
of their excretion.
46. Nor indeed need the magnitude itfelf, to fay nothing of the immenfe
number, always deter you from fuppofing them to be hepatic. That the
calculus was, without doubt, " of a furprizing magnitude," which a certain
woman had difcharg'd by ftool, Vaterus (x) teftifies : and yet the woman dy-
ing a little after its difcharge, five others, of a letter fize, were found in her
gall-bladder, being " of luch a figure that it might be feen how they had
44 adher'd to that larger one," which refembled a little heart. You fee,
therefore, that this had all been in the cyft with them ; and that its magni-
tude waj no hindrance to its being difcharg'd from thence, and coming down
into the cavity of the inteftines.
That alio was large, inafmuch as it " equall'd the joint of a man's thumb,'*
which the mother-in-law of the celebrated Van Swieten (jy), who was liable
to periodical paroxyims of the j.iundice, difcharg'd from the inteftines, at the
end of two days, after very ievere, and excruciating, pains in the feat of
the duodenum itfelf; and which was hollow'd out into two cavities on its
furface, that fhow'd two calculi flill to remain, which were, themfelves,
alfo difcharg'd afterwards, being not much lets in fize than the former. And
yet the great bulk of this calculus had not prevented it from ftruggling
through the narrow paifages of the ducts.
Nor is it to be wonder'd at: for although the ductus choledocus is narrow,
although the cyftic is ftill more narrow, and the paffage of it impeded by
valves, they are neverthelefs membranous, and, for that reafon, can bear
almoft incredible dilatation. And from this caufe it was that Bezoldus (z)+
found the cyftic duct " eight times larger than it generally is, fo as to equal
" the thicknefs of a man's thumb ; and in the middle of its length, a cal-
" cuius of a remarkable fize." And I myfelf, as is faid elfewhere (#), have
feen, " the common and cyftic ducts, and the hepatic quite within the liver,
" ib dilated as to have a circumference equal to two inches," in an old man,
ia whofe cyft, but particularly in the branches of the hepatic duct, I found
calculi.
(t) N. 25. 26.
(«) N. 16. & feq.
\x) Diff. fupra ad n. 16. cit. thef. 3,
5
(j) Comment, fupra ad n. 15. cit. §. 950.
(z) Diff. de cholelitho caf. 1. n. 5.
(«) Epifl. anat. 1. n. 43.
But
272 Book III. Of Difeafes of the Belly.
But in a woman vvhofe gall-bladder conrain'd a large calculus, although
not yet quite indurated, the orifice of the common canal, where it opens
into the duodenum, which is, at other times, very narrow, was feen, by Hci-
fter (£), to be fo dilated, " that it could with eafe admit the little finger of a
lt man." And Hen. Albertus Nicolai (c), having found the fame canal ex-
panded quite to the gall-bladder, " in a very extraordinary manner," found
the orifice no lefs open than it was found by Heifter. But the younger du
Verney (d) had even feen it larger. And Trew (e) had feen it very lax in a
body, wherein the biliary duds were equally dilated : the diameter of which,
was found to be three times larger than it naturally is, by Kniphofius (f).
Other oblervations of this kind, which were at hand, I omit to mention •,
for thefe that I have mention'd, are not only fufficient, but I mail produce
iome prefently (g), among which there will be one inftance of a much greater
dilatation. Since, therefore, thefe canals may be fo dilated, and are found to
be fo dilated, there is no reafon why we mould doubt that gall-ftones, even
when they are of a confiderable fize, may pafs through them •, except when
thofe pains in the right hypochondrium, which are the natural effects of fuch
a dilatation, have not preceded. Wherefore as I commend Hoffmann, when
(peaking of thole twenty ftones of a remarkable fize (b), for not fup-
pofing it altogether incredible, that in the duels whereof I fpeak, " very
" fmall bilious calculi might firft adhere, and, by degrees, get an increale
" from the bile which flow'd by them, and a great dilatation of thefe duels
tc being fuccefllvely made, be obftructed there, for a long time ;" fo again
I commend the fame author, even ftill more, becaufe he has mown him-
felf to be doubtful, and even more inclin'd to the contrary opinion, for this
reafon, becaufe thefe ftones had been difcharg'd, " without any violent pains
" of the right fide having preceded.'* ■
I alfo fet down as commendable in Bezoldus (i), that though pains of the
right hypochondrium had, for the fpace of fix years and more, preceded the
difcharge of a gall-ftone ; and although he, himfelf, and not without reafon,
judg'd it to have proceeded from the biliary duels ; yet he profefs'd that he
would " not obftinately adhere to the opinion," I fuppofe becaufe there
had not been an unufual feverity of pain in that part, and greater than at any
other time, when the ftone, having, at length, overcome the narrow paries
of the orifice of the ductus communis, fuddenly burft forth into the inteftine ;
or, at leaft, becaufe there had been no exacerbation of pain, in proportion
to the great bulk of the ftone : and if it had been confin'd in thefe duels, fo
long a time, it certainly could not but have brought on a jaundice, unlefs
fome extraordinary difpofition of the duels be fuppos'd ; ytt there is not a
word faid of either of thefe appearances.
I wifh I could fpeak equally in commendation of Abraham Vater (£), in
other relpecls a learned, and fagacious phyfician, who does not doubt but
two calculi " of a confiderable magnitude," that were difcharg'd by ftool,
(b) Aa. n. c. torn. 1. obf. 181. (f) Eorund. t. 8. obf. 30.
(r) Commerc. litt. a. 1732. hebd. 33. n. 11. (g) N. 47.
fab. 4. (h) Obf. fupra ad n. 46. cit.
{d) Loco indicat. fupra ad n. 13. (i) Difl". modo cit. caf. 2 & §. 7.
{t) Aft. n. c. torn. 4. obf. 140. {&) Obf. 3. fupra ad n. 42. cit. §. 2. & feq.
" came
Letter XXXVII. Article 47. 273
*c came quite from the gall-bladJer, although " neither pain, nor any other
" troublefome fymptom, had been prcvioufly perceiv'd from them," and
though, even at the time, the excruciating pains of the belly were not ieated
in the right hypochondrium, but " had firft occupied the umbilical region,
" and, at length, fallen upon the region of the loins." Yet he is not with-
out his weight of realbns. But while among thefe, he produces examples of
the very great dilatation of the very narrow ofculum uteri in child-birth, and
of the great diitention of the (lender ureters in calculous patients, it is fur-
prizing, it never occur'd to him, that neither the one, nor the other, is ever
dilated, without fevere pains.
47. However, let us fee what may be raid for Vaterus. An obfervation
of Traftelmann is extant in Schenck (1), in which he defcribes " the me-
" atus of the bile, where it is inferted into the duodenum," as he himlelf
had found it, " wide, inflated like a ftomach, and fill'd on every fide with
*' calculi," fome larger, and fome fmaller. If youafk what was the proxi-
mate caufe t>f the patient's death (who was a man of princely rank)-, it was
a coma vigil, degenerating into an apoplexy. If with what fymptoms he
was previoufly troubled, you will find nothing at all, befide an incredible
thirft, wherewith he had been tortur'd all his life-time. And can you fup-
pofe, that the phyfician who made this obfervation, and who appears to have
been a diligent man, would, if a jaundice, or any pain in the right hypo-
chondrium, or if any other fymptom, which related to the meatus of the bile
being fo diftended with calculi, had afflicted his own prince, either have
been ignorant of it, or have pals'd it over, in an obfervation which was not
very fhort ? But if you do not believe this, you muft of courfe acknowledge,
that befides another duel by which bile might be carried to the interlines, and
a jaundice prevented, it is poflible that the meatus choledocus may, by
means of calculi, which were before very few, being gradually increas'd
therein, both in number, and magnitude, be immoderately diftended in-
deed, but fo flowly, and gently, that the patient may not at all complain
of it.
Yet whatever you may think of this cafe, you will always be of opinion
with me, that thefe things are very rare, and will, at the fame time, obferve,
that quite a different judgment is to be form'd of quiefcent calculi, and of thole
which have pafs'd through the ftreights of the whole cyitic, and common
duct, even to its termination, by force. I do not, however, require, that
as in the obfervation of Tinctorius (m), after a pain of the right fide, which
was extended to the inteftines, there be difcharg'd, together with the cal-
culi, " a bloody and purulent matter •," it is fuffkient for me, as it was
for Bartholin (»), " that the ductus choledocus alone was dilated," which
was feen by him, on a fimilar occafion ; and as, fometimes, during this dila-
tation, when the calculi are confin'd in the narrow parts of the ducts, and begin
to be mov'd from thence, the ducts are hurt by the angles of the calculi, and
the difcharge, at length, happens not without the rupture of an abfeefs^ which
was thus brought on, and an excretion of blood and pus by (tool, fo, for the
(/) Obf. med. 1. 3. ubi de cholidocho meatu (//;) Vid. fupra T1..42.
obf. 3. (») In ead. obf.
Vol. II. ;N n mofl:
274- Book III. Of Difeafes of the Belly.
molt parr, this dilatation happens with much lefs violence, but fcarcely eve
without pain.
I have already defcrib'd in a former work (o), and taken notice of, even in
the preceding letter (p), an obfervation ofValfalva, in which the upper part of
the ductus choledocus communicated with the large cavity of an hepatic ab-
fcefs, and the other part of it was enlarg'd fo as to admit the finger, and, by
this means, mow how in a living body, it could tranfmit more than two
hundred veficles, with which even then that abfeefs abounded, to the in-
teftine. Of the many which had formerly been difcharg'd by that meatus,
it is probable that fome had been obftrutted in the narrow part of the duel:,
by coagula of blood, and that the bile, the paflage of which was reftrain'd,
had by forcing from above downwards, together with the blood, dilated the
canal.
This, however, is certain, that the morbus regius, vomitings, and pains,
in particular, had preceded, which pains were fo violent in the right hypo-
chondrium, as frequently to excite the moll: fevere diftentions of the nerves.
Which fymptoms, and others there advane'd, though you may in great mea-
fure refer to fo very confiderable a difeafe of the liver, yet if any one fhould
choofe to refer fome part of them to the dilatation of the meatus choledocus,
you certainly cannot deny the plaufibility of his opinion. And if you do
not deny that this may happen without pain, in a duct which is not irritated
by angular, rough, and large (tones, but even relax'd by blood, and ichorous
matter, often flowing through it, confider whether you can poflibly fuppofe,
that the fame can happen without pains when the lower ftreights of this duel:
have not been previoufly relax'd, but even contracted, from the irritations of
the calculi ?
48. Do not expect that I fhould make this letter, which is already too long,
ftill longer, by adding many things in regard to the cure of this difeafe. Of
which it will be fufficient to hint a few things. I have already faid (q) that
this diforder often recurs, nor is certainly known, unlefs when fome calculus
has been difcharg'd, which previous pains about the region of the liver, had
prov'd to have proceeded from thence. Therefore, one part of the cure
will be to endeavour, when very fharp pains of this kind fhall return, that the
calculus may be diflodg'd from thefe ftreights. A fecond part, that if any
other calculus remains, after this has been diflodg'd, it may, if poffible, be
diflblv'd. A third, to prevent the generation of new calculi. And each of
thefe parts of the cure are to be attended to feparately, and diftinguifh'd ac-
cording to our pofition, nor ought the times, which belong to every one of
them, berafhly confounded, as fomefeem to do, who heap up remedies promif-
cuoufly upon their patients ; but the nature of the cafe, and the analogous
cure of the urinary calculus, which is diltinct in like manner, ought to be
fet before our eyes.
49. When the patient, then, is attack'd with thefe violent pains, we muft
do ail in our power to appeafe them, not only to prevent his being rack'd,
and falling into danger of inflammation, or diftention of the nerves, but alfo
(0) Epift. 3. anat. n. 10. (?) N. 42 & 44.
(/>) N. 10.
o that
Letter XXXVII. Article 50. 275
that the calculus mav get through the narrow paflages. For the more this
concretion, like a heterogenous body, irritates the duds, the more , the duels
are contracted upon the calculus, for which realbn they both inereale their
own tortures, and prevent the paffagc of the (tone. For this realbn it is ne-
ceflary to relax again and again : and to thole tilings which are, of themfelves,
relaxing, and emollient, mull be added, lor the lame end, diluters, demul-'
cents, anoydnes, and the molt temperate antifpafmodics, and, it intolerable
pain compels you, even opiates.
Nor is it necefiary to relax, only by internal remedies, but alfo by reme-
dies externally applied, as tar as it is in our power ; I mean by the ufe of
clyfters, unctions, fomentations, and baths. To all which, where there is a
fulnefs of blood, I do not fee why venajfection mould not be premis'd,
not only to prevent the chance of an inflammation being brought on, but
alio to prevent the paflages from being Itreighten'd, by the turgefcency of
the fmall veffels. Moreover, as I recommend every thing that may relax,
ib I violently fufpect every thing that can irritate. For the detriment which
they brinjr, by forcing the dudts to contract themfelves, and become ftilli
narrower, is certain •, and the advantage which many expect from the impul-
sion, and extrufion, of the calculus, uncertain.
Yet there are, you will fay, inftances of calculi reported, which powerful
impellents, or ftrong emetics, and purgatives, have diflodg'd. I grant it.
But who dares, purpofely, to imitate the happy rafhnefs of a cate, without
knowing (and who can for certain know ?) that the paflages are, already,
fufficiently relax'd, fo that nothing but the latt impulfion, and agitation, is
wanting \ and that the cafe, at prefent, is not quite the reverfe, fo that by
this rafli and hafty method, the calculus mutt be thrown into ttreights, from
whence nothing can diflodge it ; by which, not only the pains become more
excruciating, but the danger is greatly increas'd.
And indeed I fee Hoffmann afferting (V), that emetics " are often found to
" be highly pernicious, if a calculus, inherent in the ductus cyfticus,
" produces very grievous anxieties about the prascordia •," and Reverhorit
(j), " readily confefiing," that emetics " are a doubtful kind of remedy,"
whatever duct is obttructed by the calculus; and, finally, Scheffelius(/), pur-
pofely to omit others, for the fake of brevity, exprefly fays, in regard to
purging medicines: " this I certainly would not imitate, as I fhould fear left
" the calculi were lb fituated, at the fame time, that they could not be
" expeli'd, but might be difturb'd in their fituation, and the pains from
" thence, exafperated," which even anger alone, as he immediately fhows,
and not only the ftimulus of purging medicines, eaiily excites.
50. You perceive that he fpeaks of purging medicines, at the time, alfo,
when the pains have ceas'd, by reafon of the calculus being difcharg'd : which
is the fecond part of the cure. And I would, even then, abttain from pur-
gatives, for the reafons juft now mention'd, and would rather cleanfe the
inteftmes, by more mild remedies, left the calculus that lias been thrown in-
to their canal, fhould happen to be obttructed there, and get fuch an in-
(>■) C. 12. fupra ad n. 44. cit. in cr.utel. §. 1. (t) Diff. fupra ad n. 13. cic $. 30.
(s) Difien. fupra ad n. 16. cic. §. 66.
N n 1 create
276 Book III. Of Difeafes of the Belly.
ereafe of bulk, as would make ir, fometime or other, hurtful to the patient:.
And I would have you beware of calling me a too timid practioner, for this
reafon, or if you choofe it, even call me fo •, for I am lefs afraid of this, than
of being call'd a very bold one, or, at leaft, in this fpecies of diforder, in
particular, wherein, as is demonstrated above (a), frequently no kind of in-
convenience is perceiv'd, when the calculi are in a ftate of reft. For which
reafon I would have you ceafe to wonder, that in this fecond part of the cure,
I have omitted the consideration of impellents, and have only propos'd this
one thing to be done, I mean that if any calculus fhould happen to remain,
it may be dhTolv'd, provided it be poflible to diflblve it.
It does not, however, efcape me, how little the remedies, recommended
for this purpoie, generally anfwer the expectations of the patient, or the
promifes of the practitioner, whether they are of a mild kind, which I would
willingly admit,"- or of a very acrid nature, or in any meafure irritating,
which I would fhun. Nor is it to be wonder'd at -, fince even out of the
body, the calculi which are long preferv'd in thofe fluids, by which, with-
► in the body, they are fuppos'd to be diflblv'd, are by no means diflblv'd, un-
kfs they happen to be of the fofter kind, fuch as Borrichius (x) faw " almoft
" wholly diflblv'd in warm water," and after him Hoffmann (y) ; and I, even •
in water which was not warm, have feen them contract fifures, and burft into
fragments, as I have written to Schroeckius (z). And they even fometimes,
of themfelves, break afunder into imall pieces, as I have obferv'd in fome
black ones ; or even melt into a moifture, as that which Lanzonus (a) ob-
ferv'd " to be fpontaneoufly diflblv'd, into a green liqour."
For although, in order to defcribe this calculus, he fays that " he had
" found the whole of the bilious juice to be ftony," he has either abus'd the
word " ftony," in order to fay that the bile was converted into a calculus,
or the cruft feem'd in great part to be ftony, whereas the internal fub-
ftance was very foft. On the contrary, the juncture may be very foft, and
the fubftance, nevcrthelefs, extremely compact. Thus Platner (b) faw that
the fragments of a calculus, which, not being very clofe, " had loon fallen
" into pieces, could neither be diflblv'd by warm water, nor by fpirit of
" wine, although they were fteep'd in thefe liquors, for feveral days together,
" in a warm place." So alfo Bezoldus (7), having left little pieces of cal-
culi, both in warm water, and fpirit of wine, even rectified for fome time,
did not fee that they were " entirely diflblv'd." Nor did Hoffmann (d) fee
" that gall-ftones, which were of a more folid texture, and faturated colour,""
were diflblv'd in this manner.
Vallifneri (<?), on the other hand, has experienced that rhey are diflblv'd
by no liquor more eafiiy, than by rectified fpirits of wine made hot, and the
fpirit of turpentine. And in regard to the fpirit of wine, he has the author
of whom Haller (■/) fpeaks agreeing with him ; but fome diflent from him
in regard to the other fpirit, and amongft thefe Tacconus (g), who entirely
(a) N. 37. 38. (<r) Dii£ de cholelitho §. 5.
(x) Apud Bartholin, cent. 3. epift. med. 85. (d) §. 6. paulo ante cit.
(j) Cap. 3. fupra ad n. 44. cit. §. 6. (e) Epiit. fupra ad n. 13. eit.
(z) Obf. fupra indie, ad n. 20. (f) Nota " r" fupra ad n. 25. cit.
(a) Eph. n. c. cent. 3. obf. 62. (g) Supra ad n. 16. cit.
(£) Progr. fupra adn. 17. cit.
differs;
Letter XXXVII. Article $o. 277
differs in refpeft to them both. The lame author •, not to be too prolix*
fi nee you may, ofyourfelf, fee in the authors, whole names I have men-
tion'd, and in others alio, fuch experiments made with thefe and other li-
quors ; the dune author, I fay, although he had feen one of thole calculi, ot
which he has firrt fpoken, that he had thrown into fpirit of nitre, " be-
" come very tender," nevcrthelefs affirms of thole which he fpeaks of lalt,
that they " were not at all'chang'd" by that fpirit, which both Vallifneri(^),
and Bezoldus (i), had, in like manner, obferv'd.
From thefe varieties you will, moreover, learn this circumflancc, that we
mould not know what lithontriptic we ought to life, in this, or in that par-
ticular cafe, if it were certain, that thefe calculi, as they are, for the molt
part, lefs hard, and more friable, than the urinary calculi, lb they are more
eafily diliblv'd by their peculiar lithontriptics : although in comparing both
together, not only the fubftance, and the adhefion, or joining, of the parts
are to be confider'd, but alio how much fooner the dilTolvent liquor,,
and how much greater a quantity of it, is carried to the urinary paffages
than to the biliary.
And on account of this animadverfron it was, that, although in the flrfl
part of this cure, very large draughts of warm water are propos'd by
many, I faid nothing thereof, which is a fubject I fhould not have been filent
upon, if the fame were propos'd, when a calculus was confin'd in the kid-
nies, or ureters. Yet if you afk which I would felect in particular, out of
fuch a number of different remedies, that are promifcuoufly recommended
by many, in this fecond part of the cure-, no others more readily, I fhall an-
fwer, than thofe which are the moll incapable of doing harm -, as, for in-
fiance, the juice of taraxacum, fince with this Boerhaave is faid, by his
difciple SchefYelius (k), " to have often cur'd the calculus of the liver fuc-
" cefsfully," or of frelh grafs, which has been celebrated by every body,
fince Glifibn (/), and Sylvius (»;), for this purpofe. And certainly the il-
Juftrious Van Swieten (»J, has mown what may be done in fuch a cafe, by
this one herb alone, from the example ef a certain pauper.
This author, alfo, having overcome this diforder in others, likewife, by
decoctions of grafs, and taraxacum, and by other things taken conftantly,
for a long time together, fays, " that he had then always found calculi,
" or, at leafl, calculous coagula, in a very confiderable quantity,, in the
" flools." And although he confefTes, that he was not, for this reafon,
certain that thefe were " the parts of comminuted calculi," rather than the
fmall beginnings of new calculi, fuch as I have more than once demon-
flrated, above (0), to be found in the cyft; yet the obfervations of GlifTon,
which he himfelf alfo allows of, fnffieiently fhow that thole calculous tubu-
H (p) which are form'd in the biliarv paffages, of oxen, in the winter, are
difTolv'd by feeding on frefn grafs ; for other wife, he would not have found
thefe tubuli frequently " about the time of Lent, orEafter only, or before,"
but afterwards equally.
(h) Epift. cit. (m) Prax. med. 1. i..c. 4J. n. 1-.
(:') Di)T. cit. §. 6. (n) §. cit. fupra ad n. 46.
(i) Differt. fupra ad n. 13, cit. §. 31. («) N. 19.
(/) Anat. hepat. c. 7. (j>) Vid, fupra, n. 12-.
r.i. Finailr..
278 Book III. Of Difeafes of the Belly.
51. Finally, the third part of the cure will prevent new calculi being ge
nerated, in the "firft place, if itfhall be able to amend whatever diforders there
may be in the liver, and, in like manner, in the blood, upon which the pro-
duction of calculi depends: in the fecond place, if it remove thole things by
which thefe diforders are us'd to be brought on. Thefe diforders in the liver,
are a weaknefs, laxity, obftruction, and other things of the like kind ; and
in the blood a quantity of viicid and earthy particles, and a flow propulfion
thereof, elpecially through the liver. Moreover, thefe diforders are brought
on by the too frequent ufe of unwholefome meats, and drinks ; by the bad
digeftion of the fame •, by the quantity of diluting liquors not anfwering to
the quantity of food taken in •, by too much deep •, by a fedentary life ; espe-
cially by bending the body too much forwards ; by violent paffions of the
mind, and any other caufes which you fee plainly, of yourlelf, ought to be re-
mov'd by the phyfician.
But, without doubt, this part of the cure is fufficiently treated of by many.
Yet as it very often happens, either by the conformity of the patient not be-
ing fufficiently continu'd,, or by the difficulty of bringing back the liver to its
perfect found ftate, juft as we fee in the cafe of urinary calculi, that new
ones are generated ; neverthelefs, it will, at lead, be worth while to endea-
vour, that, as far as is poflible, the canals of the bile may be preferved foft,
and lax, that they may not give great refiftance to the new calculi which are
to pafs through them, but may eafily yield -, and this will be brought about,
by means of a continual, but moderate, ufe of diluters.
52. As to the lithotomy which has alfo lately been thought of, in the gall-
bladder, do not be furpriz'd that I made no mention of it above. For, in
the firft place, the pains which are excited by gall-ftones, that are endea-
vouring to difcharge themfelves, are not only brought on by thofe which come
from the cyft, but alfo by thofe that come from the hepatic dud. In the
fecond place, thofe cyflic ftones which are the largeft, and on account of
which this lithotomy feems, to fome perfons, to be chiefly defirable, neither
endeavour to difengage themfelves, nor create any great uneafinefs ; or, at
leaft, for the moft part. And to thefe we may add, that unlefs fome acci-
dent has united the gall-biadder with the peritonaeum, the cutting of it is
deftructive ; and although this connexion has taken place, in fome bodies,
from the effect of difeaie, in which chance gave occaflon to fugged this new
ipecies of lithotomy, as it often has fuggefted other things, yet how feldom
fuch a connexion is met with, even in a morbid ftate of thefe parts, is well
known to anatomifts : and furgeons know very well, how difficult it is to be
certain when it does really exift.
Laftof all, although there were no danger in cutting, can you fuppofe
there would be no great difficulty in healing the wound ? We have, before
our eyes, examples of three women, one of Bologna (q)t of Frandort (r),
and of Gottingen (5), in whom a tumour, having arilen in the epigaftrium, and
being open'd, either by art, or fpontaneoufly, difcharg'd cyftic calculi at its
aperture. I read that the firft was curd : that the fecond had "a fiitula left,
by which a thin and chylous kind of liquor, but of a yellow colour, diftiil'd :
(?) Vid. Taccon. fupraad n. 16. cit. (rj Act. n. c. torn. 6. obC 69.
and
Letter XXXVII. Article 53. 279
and the third had an ulcer remain, which, with itsfanies, difcharg'd " bilious
" calculi at times." And this laft hlftory may, perhaps, lead the i'urgcons in-
to hefitation, whether the wound mould be fhut tip afterwards, or kept open,
•in feme mcalure, tor rear of" new calculi.
It does not efcape me, however, that before the fwelling occupies all the
mufcles which lie before the cyft, caules a confiderable iuppuration on all
fides, and the pus forms winding finufles for itfelf, which require fo much
diligence, and application, in the cure, as in the Franckfort woman ; it does
not, I fay, efcape me, that the cafe mud, of courie, turn out more fuccefs-
fully, with thole who open, by incifion, the cyft which has now clofely coa-
lefc'd with the peritonaeum : and that the figns of fuch a coalition have been
pointed out by a fkilful furgeon. Nevertheless, as it is a thing that is entire-
ly new, notwithstanding it may fometimes have great utility, 1 thought it ra-
ther became me to wait till time fhall confirm its advantage, and remove all
doubts, dangers, and difficulties, by many repeated experiments, than to
be in hafte to propofe the operation, juft as if it were altogether perfect.
53. Thus you have a treatife on biliary calculi •, not that, indeed, which
Vallifneri wifh'd for (/) ; but as much as it was in my power curforily to add
to thefe things of which I had written, lefs at large, before, once, twice,
and even three times. And if Sofigenes, as you have it in Pliny («), " in his
" three meditations, although he was more accurate than others, did not
" ceafe to have doubts, and frequently to correct himfelf j" do not wonder
that I, though not a negligent man indeed, but yet by no means to be com-
par'd with thofe who have hitherto written of thefe calculi, lhould have added
this fourth meditation to the three former. Farewell.
(/) Haller opufc. pathol. obf. 33. hift. 8. (u) Nat. hift. 1. 18. c. 25.
(/) Epifl. fupraad n. 13. cic. adnot. 2.
LETTER
280 Book III. Of Difeafes of the Belly.
LETTER the THIRTY-EIGHTH
Treats of the Hydrops Afcites, Tympanites, of the Dropfy
of the Peritonaeum, and of others that are call'd en-
cyfted Dropfies.
I Am afraid that the very long letter which was lately fent you from me,
will be fucceeded by one ftill longer, as I fee that the twenty-firft fecYion in
the Sepulchretum, the argument of which I mult now purfue, that is de
Ventris Tumore Hydrcpe, is fo prolix. For in regard to the nineteenth fection,
which is entitled de Scorbuto, or the twentieth, entitled de Cachexia Anafarca^
Lecuopbkgmatia, I have no reafon to dwell upon either, fince in thofe cities,
wherein I have fpent my life, it happens very rarely, if ever, that any one
is carried off by the fcurvy •, and you will find diffeciions of thofe who have
died of this diieafe, up and down among other authors, and fome particular
di fleet ions in the writings of Poupart (a) and Mead (b) •, and the three other
diforders, cachexy, anfaraca, and leucophlegmatia, are of fuch a kind, that
they may, with much more propriety, or at leaft with much more convenience,
be refer'd to other heads. ■
Wherefore, tfc fection that is dedicated to them ■, when you takeaway the
Scholia, and the obfervations, which, as we are exprefsly admonifh'd, relate
to fevers, phthifis, pains, or tumours, of the belly, melancholy, paralyfis, dy-
fpncea, fyncope, or other diforders, and one of which is, in the mean time,
repeated (c); is reduc'd to but a fmall number: and many of theie relate
equally to other fubjects, and particularly to dropfies of the abdomen. And
if the afcites and tympanites, of which I am to treat, were the only fubject-
matter of the twenty-firft lection, perhaps this letter would not be longer than
the former. But, as befides thofe, the greater of the other tumours, with
which the belly is fubjec> to be affected, are fpokea of in that lection, I have
refolv'd to defer the confederation of thefe to the next letter, and not to treat
of any other diforders here befides both the dropfies of this cavity, and of the
peritonaeum, and of thofe that are call'd encyfted.
Yet you will not expect to have over again, in this place, thofe obferva-
tions which I have given in other places, and particularly, when writing of
the dropfy of the thorax-, for I mall only give you fuch as have not been yet
(a) Mem. de 1'acad. r. des fc. a. 1699. (<) Vid. ohf. II- §. 6 & 9.
\b) Mohit. med. c. 46.
related,
Letter XXXVIII. Article 2, 3, 4, 5. 181
related, either from Valfalva's papers, or my own. And thefe are Valsalva's
which immediately follow.
A man of iixty years of age, and troubled with a hernia, was feiz'd with
a difficulty of breathing, and thirft. His belly and feet became tumid. Ac
length, his thirft remitting, he died. The ad i pole meitibrane of the abdo-
men, and the mulcles when cut into, were found to contain a ferous matter
in their interltices : a fluid, of which kind was alio found in the cavity of the
belly. With the lower part of this cavity, on the left fide, a facculus made
out of the peritonaeum, and containing a portion of the inteftines, communi-
cated. In the thorax, the pericardium abounded with ferum. The blood in
the ventricles of the heart was fluid.
3. "Whatever was the caufe of the dropfy, in this man-, for although it
cannot be denied, that when the inteftines fall down, and form a hernia, a
lymphs-duct may fometimes be burft in the mefentery, which is drag'd down
with violence, yet that this happens very feldom, and when it does happen,
that the chyle flows out together with the lymph, we are not ignorant ; what-
ever then was the caufe, you fee that to the afcites, two other dropfies, that
is the anafarca, and the hydrops pericardii, were added. For it rarely hap-
pens, that this difeafe is fimple : which almoft all the following hiftories will
join to confirm.
4. Julia Bonetti, a woman of fifty-five years of age, (lender, and, on both
fides, gibbous, having begun, a few months before, to complain of her re-
fpiration being fomewhat difficult, was, at length, brought, on the twenty -
ninth of November, in the year 1688, into the hofpital of St. Mary de
Morte at Bologna, as a patient of the houfe. She breath' d laborioufly, and
that more when fhe lay on her left fide than on her right. But if fhe fat up in
bed, then the difficulty of breathing was fo much increas'd, that fhe was al-
moft fufibcated thereby. All remedies being of no effect, and the difficulty
of breathing increafing daily, her pulfe became weak, and languid : fhe was
attack'd with frequent fwoonings ; her face was tumid, and, in fome meafure,
inclin'd to a livid colour ; and thus fhe died in the beginning of December.
The cavity of the belly was fill'd with a limpid water. The omentum, beino-
without fat, was fill'd with certain veficles. The cavity of the thorax, on
the right fide, contain'd about four ounces of water, and the left as much as
it could poffibly hold, lb that it fiow'd out as the fternum was cut away. In
this cavity the lungs were fomewhat tumified, and of a purple colour, as if
they had been feiz'd with inflammation; but in the other, they differ'd little
from their natural ftate. The right ventricle of the heart, together with a
great quantity of concreted blood, had, alio, a polypous concretion, of the
thicknefs of a finger, which was produe'd both into the vena cava, and the
pulmonary artery. In the left, only the beginning of a concretion of
this kind appear'd.
5. Which of the dropfies preceded the other, whether that of the thorax,
or belly, is not eafy to pronounce, in hiftories of this kind. However, if
on account of the deprav'd ftructure of the thorax, you would, alio, have it
that this cavity muft firft have collected the water, I fhall not conteft the
opinion. Be this as it will, I fhould fuppofe that on account of the fame
ftructure, thofe circumftances had happen'd, which are taken notice-of in this
Vojl. II. O o • woman's
282 Book III. Of Difeafes of the Belly.
woman's hiftory, and which are fo contrary to what generally happens •, I
mean, that Ihe breath'd with more difficulty when lying on that fide, in which
the lungs were tumid, and there was a great quantity of water; and than
when fitting up in bed (lie was almoft: fuffocated.
6. An old woman began to have her whole body fwell'd, in the autumn,
to have her refpiration become difficult, and her third troublefome. To
thefe fymptoms was added, (though indeed the thirft left her before the end
of her life) a cough, attended with a fpitting of catarrhous matter, and a
difficulty of lying down on the left fide, fo that, for this reafon, fhe almoft
always lay on her right fide : and in this pofture fhe died, when her pulfe
had become fo contracted, that it could fcarcely any longer be perceiv'd.
While the fkin and mufcles of the body were cut into, a great quantity of
ferum was difcharg'd. The belly was alio fill'd with ferum, which had pro-
tuberated with a very large, but foft tumour. This ferum, being receiv'd
in a glafs vefiel, re fern bled the colour of urine, and after ftanding one or two
days, fhow'd a concretion iwimming upon it, of fo firm a nature, that it
was not broken into pieces, even by the agitation of the vefiel. The re-
maining fluid part, being put on the fire, became prefently turbid, and grew
pretty thick, and, foon after, began to fliow a flight concretion, on the fides
of the vefiel : but as the evaporation proceeded, it form'd a pellicle on its
furface : and after having decreas'd, thus, to lefs than half its quantity, be-
came perfectly fimilar to barley-cream. The liver was diflinguifh'd, here
and there, with whitifh fpots, which were externally larger, and internally
fmaller, and was in general of a pale colour. The fpleen was very hard.
The lymphatic veffels occur'd, pretty evidently, of themfelves, about the
loins, and below, through the internal parts of the belly.
In the left cavity of the thorax, the lungs were on all fides free ; but in
the right, were tied to the pleura, in the whole circumference, by many
membranous connexions, and thofe entangled with each other : and if you
handled thefe membranes, a great quantity of ferum, which had been fhut
up in their interfaces, iflued forth. In the finufies of the heart, was con-
tain'd a great quantity of blood, fluid in its confidence, and of a dilute red in
its colour, as in all the veffels likewife : and the heart was furrounded with.
ferum, vvhereVith the pericardium was not only fill'd, but had even been
extremely dilated. This ferum of the pericardium, although, in its colour,
and the firm concretion that was fpontaneoufly produe'd in it, very fimilar to
that which had been contain'd in the belly, yet did not coagulate, when ap-
plied to the fire, but being perpetually fluid, and flying off by degrees, left
only a flight crufl in the bottom of the vefiel. The ialine particles, of both
thefe kinds of ferum, were examin'd, but were not found to be of any cer-
tain figure : yet the figures of the particles of the former kind of ferum, dif-
fer'd fomething from the figures of the particles of the latter. The concre-
tion, which fwam in the ferum of the pericardium, was nearly of a fpherical
form, and feem'd to be made up of fmall veficles, as it were, collected toge-
ther into one body.
7. It was a cuftom with Valfalva, when he had found water extravafated
into the cavities of the body, not only to attend to the nature of it, but alfo
to enquire thereinto, by experiments, of different kinds ; often making ufe of
5 fire>
Letter XXXVIII. Article 8. 283
fire, and fometimes mixing ingredients with the ferum. He wan wont to
examine the fituations of the lymphreducls likewife, and to remark whether
they were turgid, or did not at all difcover themfelves. Both theft cuftoms of
his, you will remark in mod of the obfervations of this kind, that he has
left, but particularly in that which I have juft defcrib'd. He meant to in-
quire, I fuppofe, by both thefe methods, from whence the water had pro-
ceeded, whether from the. rupture of thole veffels, or from any other caufe,
that he might, perhaps, after a long feries of obfervations, attain fo far, as,
from a portion of water, taken from a dropfical perfon when living, to be
able to diftinguifh that this had flow'd out of thole veffels, and, conlequent-
ly, to pronounce the diforder incurable.
For fuppofing this diagnofis, as, for inftance, in an example I have al-
ready taken notice of to you (d), this prognofis follows, which was equally
unknown to the ancients, as thofe vefiels themfelves : by the difcovery of
which, fome, who have rebuk'd thofe that apply very diligently to anatomy,
imprudently contended that the prognofis, in this diforder, was not at all
chang'd ; and this being thus chano'd, it is evident that the method of cure is
alio chang'd, which the fame gentlemen denied •, for why fhould the phyfi-
cian trouble, with very ftrong, and violent remedies, thofe in regard to whom
he ought to think, only how to preferve their lives, as long as pofiible, in-
ftead of attempting to cure their diforder ?
But I faid that Valfalva had need of a long feries of obfervations of that
kind, for this reafon, becaufe the lymph itfelf is different, in different bodies,
and at different times. And indeed Reverhoril (f), moreover, added the
difference of the place from whence it proceeded, faying that the afcites,
wherein a yellow, and bitter, water is drawn off, arifes from the lymphatic
veffels of the liver being injur'd. But as I do not think it neceffary to de-
pend upon his authority, fo I do not think it fufficiently fafe, to agree with
thofe who affert with Bonetus (f), that the water of dropfical perfons, which
is " limpid, colourlefs, or but (lightly ting'd," is from the lymphasducis, but
that the water which is like " ferum, fometimes pure, fometimes mix'd with
" other humours, and refembling the colour of urine," proceeds from the
veins. For although in the patient of whom he fpeaks, whofe urine feem'd
to be a lixivium of a quite black colour, rather than of a colour almolt black,
that limpid water, which hedeicribes, could have flow'd from no other parr,
but from the lymphasducts, into the belly, yet in others, whofe urine is of
a different kind, it may have come from fome other part.
8. And again, if the lymph, which was at firft limpid, be chang'd by
ftagnation, and mix'd with the putrid eluvies of the vifcera, which even itfelf
does at length corrupt, muft we, for that reafon, fuppofe it not to have come
from the lymphasdudls ? To this add the feveral fallacies, which, without a
very clofe, and accurate attention, may often impofe upon us, in the diflec-
tion of bodies. For the water, which firft flows out, will be fometimes lim-
pid, not that it was fo in the patient: when living, but becaufe the grofler
particles having fubfided, in the dead body, the water, which lies uppermoit,
(</) Epift. 16. n. 5. (/) Sea. hac 21. fchol. ad obf 18.
(ej DiiT. demot. bilis §. 21.
O 0 2 be-
284* Book III. Of Difeafes of the Belly.
.becomes very pure. On the other hand, fometimes, when it was pure in the
living body, it is made impure from the very diffection.
Thus I formerly obferv'd, when I had begun to divide the ribs from the
fternum, in a certain dropfical woman, that the water burft forth in a flate
of perfect limpidnefs : but when I had divided all the ribs, and taken away
the fternum, that the water appear'd to be redifh : finally, when I had hand-
led the vifcera, andjufl begun to cut into them, that all the remaining water
had contracted a red colour. And thefe circumftances ought to be the more
attended to, in proportion as there is lefs water originally, or lefs remain-
ing, fo that a little blood being gradually, and almofl clandeflinely, mix'd
with it, the whole may be ting'd. There are hydropic waters alfo, which
have impurities mix'd with them, even before difiection, from a difeafe in
fome vifcus or other, as I have already hinted, which is lefs likely to deceive
us, where the difeafe of the vifcus is confiderable, and where there is a great
quantity of water.
Thus in the difiertation of Schacherus (g)> as to the afcites was join'd an
increas'd and difeas'd flate of the ovary, it was not furprizing, that the wa-
ter, which was, in other refpects, pretty limpid in appearance, mould, by
means of evaporation, " have foon coagulated into a fat fubftance, in fuch a
" manner, that one fourth part of it only, had confuted of water, which
" was evaporated, and the other three were made up of the febaceous por-
" tion, which remain'd behind." So I alfo remember to have heard Alber-
tini fay, that the waters of fome hydropic perfons, by being expos'd to eva-
poration, had flown off in a very fmall degree, but had in great meafure, I
iuppofe from fome caufe of this kind, coagulated ; whereas the waters of others
had, on the contrary, chiefly flown off, by applying the fame degree of
heat, and a very fmall part, only, concreted.
But we muft be extremely cautious, when the difeafe of the vifcus is fo
fmall, that it may eafily efcape the eyes of" the diflecter, left if any part of
the water coagulate, by the force of the fire, it fhould not be refer'd to its
true origin. From thefe things, and others, which I purpofely pafs over,
I would have you underfland why I faid it was neceffary, that Valfalva fhould
have made a great number of thefe obfervations, which I do not defpife, but
only require to be made with the mod cautfous, and exact diligence ; fo
that thole in which there might be any fallacy- being fet afide. he might
apply the others, compar'd with fimilar experiments on the lymph, and on
the ierum of the blood, to thofe purpofes which he had propos'd to him-
klf, whatever thefe might be, with advantage. To this kind of companion
we are exhorted by the celebrated Phil. Frid. Gmelinus (b), when he propofes
his experiments upon the water of an afcites, taken from a certain woman.
Others you will read upon the fluid, which the veficles of an encyfled dropfy
contain'd, made by the celebrated Jo. Chriftop. Pohlius (i). And fome
more Ample experiments, as evaporation was alone made ufe of, you will
find in the writings of the illuftrious Senac (k). You will find fome peculiar
ones, that is to fay, fome which relate to a milky dropfy, that arole, as it
(g) Difl". de virgine afcit. (A) Traite da Coeur. I. 4. ch. 3. n. 4. & ch.
(i) Commerc. litt. a. 1745. hebd. 52. n. 3. 9- n. 2.
(/) Ad. n. c. torn. 8. obf. iii.
4 feems,
Letter XXXVIII. Article g, 10, u. 285
feems, not only from chyle pour'd out of the chyliferous veffels wlien rup-
tur'd, as in the obfervation or' Littre (7), but alio from this fluid being mix'd
with a great quantity of that water, which is common to patients troubled
with an afcites •, you will rind them, I lay, in the hiitory of the Royal Aca-
demy of Sciences at Paris (m). But what kinds of water are, for the mod.
part, drawn off" from droplical patients, and how various thele are, the
younger du Verney has taught in another part of the memoirs of the fame
Academy (n) ; and that in a more fimple way certainly, as, without making
ufe of any external afiiltance, he depends upon his fcnfea only ; but in a
much more commodious manner, and one that tends to be of more extenfive
ufe, in forming a prognofis.
9. But left we fhould fecm to be forgetful of the old woman, whofe hii-
tory I have given you (o), if you compare it with that which immediately
precedes, of the gibbous woman (p), and with the firft of the man (^), you
will perceive that the old woman's lying-down was juft luch as the fide of
the thorax, that was mod affected, required. -And in regard to the thirll
which remitted before death in the man, and was remov'd in the old woman,
you may conceive of it in this manner •, that either the power of feeling was
grown very obtufe, near the time of death, or that when the belly was quite
diftended, the moifture, which remain'd in the blood, went in part to moil-
ten the fauces, as the catarrhous matter, which the old woman fpat up, demon-
itrated. For it is not neceffary to fuppofe that the ferum of the blood is un-
fit to remove thirll, in all droplical bodies, I mean that it is more like brine,
as has been found by fome who have tailed it, than water.
10. The belly of a man of fifty years of age, who had labour'd under an
univerfal dropfy, notwithstanding there appear'd no tenfion externally, was
full of water. The liver was of a black colour, the ipleen was lbmewhat in-
creas'd, the other vifcera of the belly were found. The lymphaxlu&s were
extremely turgid: and as there were many glands below the emulgent vef-
fels, near to the vena cava, and round the great artery, thofe du<5ts were
carried from the mefentery to thefe glands, and from thence into the thoracic
duel.
In the thorax was a watry humour, and the lungs were variegated with
black fpots. The pericardium was lb far expanded with its proper dropfy,
that it refembled the urinary bladder of an ox, when diftended with air. As
all the veffels of this body were large in proportion, fo the heart was alio
large; and the left auricle thereof fo dilated, that it almoft equalled one half
of the heart, when of its natural fize. And the heart had thefe remarkable
appearances, that the external membrane was eroded on the left fide, and the
veffels had varicous contorfions •, but in the ventricles it contain'd a fluid
blood, without any fign of concretion.
11. It is not eafy to fuppofe that Valfalva-, as he had found the pericar-
dium to be fo greatly diftended with water, and the left auricle to be fo en-
(/) Hid. de l'acad. r. des k. a. 1710. obf. (0) N. 6.
anat. 7. (p) N. 4.
(m) A. 1700. (?) N. 2.
[n) A. 1703.
larg'd,
586 Book III. Of Difeafes of the Belly.
larg'd, that from hence, in all probability, as the motion of the blood muft
be on all fides retarded, fo an univerfal dropfy was in great meafure the con-
fequence ; it is not eafy, I fay, to fuppofe that he had not enquir'd, minute-
ly, into all the fymptoms with which the patient had been troubled, or that
if he had heard of any thing peculiar, he would not have remark'd it. Yet
in regard to the dropfy of the pericardium, as the old woman, alfo, of whom
I fpoke above (r), had her pericardium very much dilated with water, you
might have feen among the fymptoms related in that hiftory, whether there
was any thing peculiar to the dropfy of the pericardium, rather than the
other preternatural appearances, which were found at the fame time.
At leaft, it was not, in the beginning of the difeafe, very difficult for the
patient to lie down, nor neceffary in the latter part of it; nor is it faid to
have been with the head declin'd : which things you will compare with thofe
that are made mention of by me, where I have examin'd, with a ftudious
defire after truth (s), other fymptoms of that dropfy which have been pro-
posal by other writers. But left you mould begin to fufpect, from the next
obfervation which I mall fubjoin, that the peculiar fymptom thereof, is a
necefilty of lying in afupine pofture, you muft attend to many other hiftories
in which the diforder was without this fymptom, but, in particular, to that
which will immediately follow the next.
12. An old woman of feventy years of age breath'd with difficulty, was
very thirfty, troubled with a dry cough, and could lie only in a fupine pof-
ture. After thefe fymptoms had lafted for a long time, and the feet began
to be cedematous, fhe died.
The belly was full of water. The lymphseducts about the great artery,
where it gives off the emulgents, were turgid ; in the mefentery, and elie-
where, they fcarcely appear'd. The kidnies were fmall, and without hyda-
tids. In the thorax the lungs were found : and a fmall quantity of ferum
was contain'd there. But the pericardium was full of it : in which the heart,
being twice as big as it naturally is, contain'd a flaccid polypous concretion :
and the auricles contain'd blood, with which they were very turgid. How-
ever the blood, in this body, preferv'd its natural fluidity, and colour.
13. An old man of feventy was troubled with an cedematous fwelling of
the feet, and a great thirft, and was feiz'd with a cough that was, at times,
fo painful, and vehement, as to make him feem on the point of fuffocation.
He fpat up a catarrhous matter : he breath'd with difficulty : he could lie
down in a fupine pofture only : his pulfe was low and weak. He died.
In the belly water was extravafated : and the lymphseducls, about the
divifion of the emulgent veflfels, were fo tumid, that three or four were, each
of them, feparately taken, equal in thicknefs to a goofe quil. The fpleen
was very large, and fhow'd fome fmall bodies on its external furface, like the
grains of millet feed.
In the thorax, both lobes of the lungs adher'd to the back, the fides, and
the fternum, leaving interfaces betwixt themfelves, and the pleura, which
contain'd water. On the other hand, in the pericardium was no moifture :
and this part, itfelf, began already to be connected to the heart, by many
(r) N. 6. O) Epift. 16. n. 4,-.
mem-
Letter XXXVIIL Article 14, 15, 16. 287
membraneous fibres. In the ventricles of the heart was a coagulated blood,
and in the right auricle alfo, in which, at firtt fight, it refcmbled a portion
of the uterine placenta. In the left ventricle was a polypous concretion,
which was univcrfally unconnected.
14. You fee, therefore, by comparing both thefe obfervations together,
that although a lupine pofture of lying down was, in both cafes, necefiary,
the pericardium, neverthelefs, was not in both calcs full of ferum, and even
that in the old man, it contain'd no moifture at all. And if you compare the
dilbrders of the vifeera one with another, you will find, indeed, that they
were confiderable in both the hiltories, but not the fame. Nor had both of
them the lame ftate of blood ; but even, which you might alfo have obferv'd
in the hydropic pcrlbns i'poken of above, that it was quite different in the two.
For in the old woman it was fluid; in the old man coagulated: and what
polypous concretion it had, was in her flaccid and lax, in him pretty com-
pact, ajid, what was rarely obferv'd by Valfalva, in the left, ventricles, not in
the right. The caufes, therefore, of making ufe of one and the fame pofture,
in h ing down, are various, and are. frequently difficult to be accounted for,
as I have lhown already (/) ;. and as will be fhown by comparing the two fol-
lowing obfervations with each other, and with the lalt foregoing.
15. A woman of a (lender habit, and in the twenty-feventh year of her
age, having, four months before, receiv'd a wound at the navel, breath'd
with difficulty, was very thirfty, expectorated a little, and complain'd of a
pain in the left part of her thorax, on which fide, as well as her back, fhe
could not lie down. All thefe fymptoms growing very violent, fhe died.
In the belly, all the vifeera were found; fo that even in the inteftines,.
where they correfponded to the navel, not the leaft mark of difeafe could be
diftinguifh'd, befides a colour inclining to blacknefs. Yet the cavity of the
belly contain'd three or four pints of yellowifh water.
The cavity of the thorax, alfo, on the left fide, was full of water, per-
fectly fimilar to that of the abdomen, this circumftance excepted, that cer-
tain concretions, like pellicles, fwam therein. In this water was contain'd the
lobe of the lungs, in a very found ftate, and free from all adhefion. But
the right lobe of the lungs exactly fill'd its. cavity, inafmuch as it adher'd to
the pleura, every where, fo clofely, that it could fcarcely be feparated : and
it was a little indurated, fo that it feem'd to have been, in fbme meafure, at-
tack'd with a phlegmon. Both ventricles of the heart contain'd a lax poly-
pous concretion ; yet the right a larger than the left. But in this body the
lymphaeducls were not at all turgid.
16. A young man, of about feventeen years of age, was feiz'd with a
difficult refpiration, with a dry cough, and a very great third. He dif-
charg'd but a fmall quantity of urine. He had a. little pain on his right fide,
and lay continually upon it. At length he died.
The belly was full of water : the inteftines, and ftomach, were whitifli :
the whole liver was hard : but the fpleen, except that it was fomewhat en-
larg'd, was, in other refpects, found. The lymphasducts were not turgid,
as is fometimes obferv'd in dropfical bodies, when the vifeera are found.
The cavity of the thorax, on the right fide, overflow'd with water. There -
(/) Epift. 20. n. 25. & alibi.
in,.
288 Book III. Of Difeafes of the Belly.
in, alio, the lungs had grown hard: and on the whole of the furfaces, by
which this- lobe was turn'd to the diaphragm, and mediaftinum, did it adhere
to theft parts. In the pericardium was little or no (brum. In all the vef-
ic Is, even in thofe of the vifcera, the blood was fluid.
17. \yhy this patient mould lie on his right fide, you immediately per-
ceive, as foon as you confider that the quantity of water, which was in the
fame fide, muft ofcourfe have opprefs'd, and fuffocated, the other lobe of
the lungs that was found, had he chang'd his pofture. But how did it hap-
pen that the woman (»)> who had water in the left cavity of her thorax, could
not lie down on her left fide ? Without doubt it is necefiary for you to con-
fider the ftate of the lungs, the left lobe of which was found in the woman ;
and the right in the young man, difeas'd. Yet how was it that the woman
could not lie on her back ? For in this pofture, neither fide would have in-
jured the other, either by its weight of water, or by the bulk of the Juno-s,
which had been attack'd with the phlegmon. The old man (x), at leaft,
though he had both lobes of the lungs lb connected all round, and, at the
fame time, prefs'd upon in the whole of their circumference, by water col-
lected in the furrounding interftices, not only was able to lie on his back, but
was under a neceffity of lying in that pofture.
You fee, then, why I faid that thefe circumftances, of lying in different
poftures, are fometimes not eafily to be accounted for. But it is better not
to fay any more of this fubject, at prefent, and to fubjoin the other obferva-
tions of Valfalva, wherein he did not fee the turgid ftate of the lymphjeducts,
join'd with the dropfy, which you might have, alfo, remark'd, in the two
hiftories juft now defcrib'd : although I fuppole it did not appear very plain
to you, or to me, why he faid, in the laft, that this turgefcency is fometimes
obferv'd in hydropic bodies, when the vifcera are found : which he certainly
could not refer to the old woman (y), to the man (%), to the other old wo-
man (a), or to the old man (£), in whofe bodies, although there was this
turgefcency, yet the vifcera were not found neverthelefs.
He muft, of courfe, then, have had an eye to other obfervations of his,
as, for inftance, that which I have already defcrib'd to you (c), in which,
when all the abdominal vifcera of an hydropic body were in a healthy con-
dition, the lymphatic veflels were turgid at the fame time : and perhaps he
meant nothing elfe here, than that thefe veflels were, fometimes, found to be
turgid, even in thofe dropfical bodies, whole abdominal vifcera are found.
18. A young man of about eight and twenty years of age, being much
given to eating and drinking, and having labour'd, for fome years, under a
difficulty of refpiration, fell, at length, into a univerfal dropfy. To this
was added, about feven days before death, a very confiderable difficulty of
breathing, with a cough, fpitting, and pain in the thorax.
In the carcafe, the belly, and thorax, were found to be full of a brownifh
ferum, and all the vifcera, except the inteftines and the ftomach, ting'd_ofthe
fame colour. This laft mentioned vile us vaftly exceeded the bounds of its
(u) N. 15. («) N. 17..
(*) N. 13. (b) N. 13.
(y) N. 6. (1) Epift. 1 6. n. 4.
/zj N. 10.
natural
Letter XXXVIII. Article 19. 289
natural magnitude. The fpleen alio was enlarg'd, three times more than it
ought to be. The bile was of a pale colour. None of the lymphseducts
came into view.
The left lobe of the lungs was very much infl.im'd ; from whence death
•was juftly fuppos'd to have been accelerated •, and was found to be con-
nected to the pleura by membranes, in the inicritices of which the ferum,
that I have delcrib'd, was confin'd.
19. That by the force of hypothefis, rather than by the authority of Hip-
pocrates, or the difieiftion of droplkal bodies, moil phyficians were formerly
indue'd to believe the liver firft, and after that the fpleen, to be the caufe of
dropfy, you will learn even from the Sepulchretum ; either in the place where
it is fhown (d), that in the books of Hippocrates, not any one, or two, vif-
cera are fuppos'd to be in fault, but many, or where (e) many examinations
of the vifcera of dropfical bodies being produe'd, both of thefe vifcera arc,
demonftratively, clear'd from the charge. And, certainly, whatever part, or
whatever caufe, can, for a considerable time, retard the motion of the blood,
or lymph, or immoderately increafe the fecretionof the moifture, with which
all the cavities of the body are furnifh'd ; or, in fhort, prevent, or dimi-
nifh, by any means, its abforption, may give origin to this diforder.
But the belly, befides thefe vifcera, has peculiar parts, from which a hu-
mour is fometimes pour'd out, into its cavity. There was, fays Piccolhomi-
nus (f), a man who drinking a great quantity, and difcharging no urine,
even by the introduction of the catheter, had his belly fwell'd to a furprizing
degree, and having at length died, fhow'd his kidnies to be entirely lacer-
ated with calculi, fo that it was manifeft the urine had flow'd out of thefe
vifcera, into the belly, and had diftended it.
In the Sepulchretum, where I have look'd for this obfervation of Piccol-
hominus to no purpofe, you have others of Platerus (g)t and Dodonsus (£),
of an afcites, that did not owe its origin to the liver, or fpleen, which were
found, but to the urine having flow'd out of the kidney, or the bladder,
which had been perforated by exulceration. And as to what is hinted, be-
fides, by Dodonsus (/'), it is by no means doubtful, but the fame thing muft
happen, if the ureters fhould chance to be burft, or eroded ■, and it is even
hinted by Galen (&), and confirm'd, among others, by Euftachius (/), that
if thefe tubes are cut into, in a living beaft, and the abdomen few'd up
again, the cavity of the belly would be found " entirely full of urine, as if
" the animal labour'd under a dropfy :" and that the fame thing had hap-
pen'd in two men, from the rupture of thefe canals, the hiftories of Abraham
Vater (»;), and Winhart (»), teach us.
To this clafs of obfervations, that of the celebrated Bernerus (o) muft be
refer'd, which was made upon a boy of fix years old, whofe urine, not being
able to get out from the kidnies, had fo diftended them, that having open'd
{d) Seft. hac 21. Schol. ad §. 4. obf. 7. (k) De natural, facult. 1. i.e. 13.
(i) Seft. ead. obf. 1. & feq. (I) Trad, de ren. c. ult.
(f) L. 2. anat. prael. 23. (m) In progr. edito Witemberg. Januar. a.
{g) Seft. cit. obf. 3. §. 2. 1720.
• (h) Ibid. obf. 25. §. 23. («) In append, torn. 2. aft. n. c. fub. n. iii.
(/') Ibid. \B) Eorund. aftor. t. 1. obf. 219.
Vol. II. P p a way
\
290 Book III. Of the Difeafes of the Belly.
a way for itfelf, through their furfaces, it diftill'd into the cavity of the belly,,
and lurrounded the interlines. And, indeed, to this clafs alfo, belong
ulcers perforating the ftomach, in fuch a part, that by affording an exit for
liquids, rather than for folids, they may either generate or increafe an afcites.
Thus it happen'd in the obfervations of the learned men Samuel Gratfius (^>),
Ad. Chrift. Thebefius (q), Rud. Jac. Camerarius (r), and Jo. Georg. Hoye-
rus (s).
Moreover, to thofe examples which are pointed out from the Sepulchre-
turn, of the liver, "tend fpleen, being without diforder, in dropfical bodies,
new examples that might be added are not wanting. Turn, for inftance,
as you may to others, and among them, to that which I juft now mention'd
ofVaterus; for it relates to this queftion alfo, and indeed chiefly ; turn, I
fay, to thofe which are fupplied by the Caeiarean Academy (0, among which
is one in particular (#), wherein every body would, the more naturally, have
fuppos'd the liver to be affected with a very confiderable difeafe, becaufe
the patient had complain'd of nothing more than of a pain in that vifcus.
Yet in this vifcus, and in the gall-bladder, was no mark of difeafe •, but in
the neighbouring part of the mefentery was found an erofion, fo confiderable
as to equal the breadth of a fpan.
However, notwithftanding the truth of all thefe things, there was no rea-
fon, why fome perfons mould run fo much to the contrary fide of the argu-
ment, as to contend that the liver, and fpleen, were very rarely, if ever, to be
blam'd. You will read, for example's fake, in one of the lali foregoing fec-
tions of the Sepulchretum (x), *' that nothing is more common, among the
" generality of phyficians, than to heap up reproaches upon the fpleen, as
" if it were the pancrene, or univerfal fountain, of almoft all difeafes." And
that they err'd in this we muft certainly confefs. Yet when it is immediately
added, " that nothing is more rare than for thofe who examine the vifcera
" after death, to detect any diforder in the fpleen •" if this be underftood
by any one, in a general fenfe, or in particular, as in an afcites, how diftant it
is from truth, will be mown, not only by the great number of obfervations
in the Sepulchretum itfelf (y), but alio by five fz), out of the nine, which I
produc'd from Valfalva, wherein it was found either to be very hard, or
larger than its natural fize, or even, as in the laft, from whence I took occa-
fion to write thefe things, three times as large as its natural magnitude. But
if the queftion be of the liver, you will lee that, in four of them, it was
either pale, or fpotted, or black, or quite hard, or that it was pallid, to-
gether with the bile. Nor is it to be wonder'd at, if the difeafe, which, as
I have already faid, arifes from a retarded motion of the blood, mould, not
uncommonly, proceed from a diforder of the vifcera, through which the
blood is carried flowly, and gently, by the intention of nature itfelf-, fo that
if any new retarding caufe be added, it cannot be mov'd but with the greateft
(p) Eph. n. c. dec. 3. a. 3. obf. 40. (u) Obf. ead. 186.
(7) ¢. 3 & 4. obf. 120. (x) Seel. 18. obf. 3.
(>•) & cent. 5. cbf. 43. (j) Vid. quot fub obf. 6 & 7. & alibi con-
(j) & aftor. t. 4. obf. 124. gerantur.
(t) Dec. 3. a. 5 & 6. obf. 13. & 168. & a. («) N. 6. 10. 13. 16. 18.
6 & 8. obf. 186.
flownefs.
Letter XXXVIII. Article 21. 291
llowncfs. Therefore, many obfervations are to be met with, in different
authors, which you may join to thole of Valfalva, and thofe extant in the
Sepulchretum •, and fo many they are, that when I mall have- pointed out to
you a confiderable number, you may take it for granted that many are ftill
remaining, in other places. See, for example's lake, what the younger du
Verney (a) found by difiection, in two virgins that had an afcites, and, in
like manner, in a great number of bodies affected with the fame difeaie, by
the Natter* Qtrioft (h) : nor pals by the appearances found by Bechmann (c)y
in an illuftrious man.
Out of all thefe diffections, of bodies that had labour'd under an afcites,
you will not read fo much as one, but you will find that the liver was difeas'd.
And you will, at the fame time, find it particularly remark'd, in fome of
them, that the fpleen was, alfo, preternaturally affected. Nor are others
wanting, from which you may perceive, that, although in this dilorder " the
*' liver was not much alter'd from its natural ftate, the fpleen was, never-
44 thelefs, enlarg'd, and fomewhat hard," or that when the liver was " quite
44 in a natural ftate, the fpleen was larger than ufual, univerfally fcirrhous,
" and fo hard, that it could not be cut into, and divided, by the help of a
" razor, without difficulty." One of which examples is from Lentilius (</),
and the other from the celebrated Cohaufenius (e).
Yet I do not doubt but the diforders, which were not in thefe vifcera, or
in the pancreas, mefentery, or other parts fhut up in the belly, in the begin-
ning of the afcites, may, fometimes, be brought on, by the dropfy being
long protracted. But there are, frequently, marks that thefe diforders had
preceded, whether we confiderall the bad fymptoms, with which the patient
was affected, before the dropfy •, or fome things are attended to, which occur
in the difiection of bodies, as the next hiftory will demonftrate.
20. A woman had labour'd under an afcites. During the difiection of the
body, none of the cavities was found full of water, but that of the abdomen.
The inteftines were not diftended with air. The liver was hard, and the
gall-bladder contain'd a ftone, which occupied the whole of its cavity. The
lymphasducts did not at all appear.
2 1. This is one of the other obfervations of Valfalva, which I promis'd you'
in the former letter (f)t in order, the more fully, to convince you, that the
jaundice had no more been obferv'd by him, than by me, to be join'd with
cyftic calculi. Moreover, it is but little probable, that fo large a ftone had not
been begun a long time before, fo as to arrive at fuch a magnitude, as to
fill the w'tole cavity of the cyft : and, confequently, that the liver, in which
bile had been for fo long a time fecreted, that was proper for the generation
of fuch a calculus, had not been without difeafe. But as to its being ex-
prefly faid that the inteftines were not diftended with air, that was done for
(a) Mem. de l'acad. r. des fc. a. 1701 & (c) Commerc. litter, a. 1742. hebd. 32.
1703. n. 1.
(I) Dec. 3. a. 5. & 6. obf. 276. & a. 7 & 8. [d) Eph. n. c. cent, 1 & 2. obf. 168.
obi". 153. Si a. 9 & 10. obf. 239. 241. 248. Si (e) Commerc. Utter, a. 1743. hebd. 25. n. 2.
cent. 1. cbf. 3. in coroll. 3. & cent. 3. obf. 12. caf. 3.
& cent. 8. obf. 27. & cent. 9. obf. 64. & cent. (f) N. 25.
10. obf. 36. & ad. torn. 6. obf. 15.
P p 2 this
292 Book II L Of Difeafes of the Belly.
this purpofe, I mean to mow that, although the afcites and tympanites may-
be join'ct together, this does not, neverthelefs, always happen, as fome feem
to believe. And, indeed, as it more rarely happens that an afcites, as in the
woman at prefent fpoken of, has no dropfy of any other cavity join'd with
it, fo it happens leis. often, that the ftomach and inteftines are diftended
with a great quantity of air, in an afcites ; and that in tympanitic bodies, a
great deal of water, in particular, efpecially when the difeafe is not yet in-
veterate, is found to be extravafated into the belly. And you will fee that
there was very little in the woman of whom I fhall immediately fpeak.
22. A woman about thirty years of age, was feiz'd with a great and moid
fcabies, after long-continu'd pains of the limbs. In order to drive this
away, fhe, by the advice of an empiric, made ufe of a certain ointment.
And by this means her fcabies was dried up in a very fhort time indeed :
but an acute fever arofe, attended with a great heat, and thirft, and very fe-
vere pains of the head. To thefe fymptoms were afterwards added a deli-
rium, a confiderable difficulty of breathing, a flight tumour of the whole
body, but not a flight one of the belly, great uneafinefs, and, finally, death
on the fixth day from her having taken to her bed.
In the difledtion of the body, it was obferv'd that when an incifion was
made into the fkin, and mufcular fiefh, no watry humour ilfued forth, fo
that it was evident the univerfal tumour of which I have fpoken, was not of
the ©edematous, or anafarcous kind : and this was alfo confirm'd by preffing
the feet with the finger, which left no traces of impreffion behind it.
The belly, alfo, was tumid, and very tenfe : yet when it was open'd, not
water, but the inteftines, and ftomach, burft forth, which contain'd nothing
but air ; wherewith they were diftended to fuch a degree, that the ftomach
fill'd more than half of the cavity of the belly. Yet into this cavity, a limpid,
ferum was found to be extravafated, to the quantity of a pint or two : which,
at firft, feem'd to concrete (lightly from the application of fire ; but after-
wards, almoft like the water of the pericardium, evaporated wholly, except
that in the bottom of the veffel, it left a kind of yellow pellicle.
In the thorax, the lungs were found to be annexed to the pleura, by a.
kind of membranes as it were, that refembled a gelatinous body : and thefe
were fo many in number, that it appear'd as if the lungs could not have
dilated themielves, fo freely as is natural. If you cut into them, a pellucid
humour iffued forth. The heart, on the right fide, was connected to the
pericardium, by fome membranous fibres : in the ventricles was a fluid
blood ; yet in the right, was obferv'd the beginning of a thin polypous con-
cretion. The head it was not in our power to open.
23. The very great and humid fcabies, which had freed this woman from
long-continu'd pains in her limbs, being improperly repell'd, brought on.
death. That is to fay, the acrid particles which had been accuftom'd, be-
fore, to prick and vellicate the membranes of the limbs, were now falu-
brioufly thrown out, by means of little ulcers produe'd on the fkin. But
when thefe ulcers were dried up, thofe particles, of courfe, remain'd in the
blood, and irritated the internal parts •, and thus brought on the acute fever,
and the other very violent diforders which accompanied it, and among thefe
the tympanites. Which fpecies of dropfy, for fo the ancients call'd it, al-
though
Letter XXXVIII. Article 23. 293
though it generally fucceeds to longdifeafes, as Littre fays (g)y is ncverthelds
lometimes brought on in an acute diforder, as this was ; and even in thole that
are (till more acute, as I mylelf have fcen, and (hall relate to you on a future
occafion.
After very violent and long-continu'd diforders, it is natural to conceive
with him, that from an effete and impoverilh'd blood, fo great a number of
fpirits cannot be produc'd,.nor of luch a kind, as are necefiary to keep up
that ipring and tenfion of fibre, requir'd in the ftomach and inteftines, in
order to refill, fufliciently, the force of the air, in both of their cavities ;
efpecially if it be much rarefied, and in great quantity ; and prevent the
parietes of thefe vifcera from being diltended, in an incredible manner. But
in this acute difeafe, the air was certainly prone to rarefaction •, fo that even
in the vefifels, which were under the fkin, and through which it, perhaps,
pafs'd with lefs freedom, it feem'd, in fome meafiire, to expand itfelf, and.
bring on a kind of flight emphyfema.
Yet fhall we fuppofe that the blood might be render'd effete, and, con-
fequently, that the coats of thefe vifcera were render'd weak, if not by the
long-continuance, at lead by the vehemence, of the diforder ? Although, as
it was, in this cafe, attended with very fevere pains of the head, with anxie-
ty, and delirium, a fcarcity, and languor, of fpirits were not fo much to
be argu'd from thence, as plenty, and irregular motions, thereof. Nor
ihall I, for this reafon, go over to the opinion of Willis, related at large even
in the Sepulchretum (£), who, in diametrical oppofition to the fucceeding
judgment of Littre, accounted for the diftention of the coats of thefe vif-
cera, in a tympany, from a copious and irregular influx of fpirits into their
fibres •, as if the fibres, that are difpos'd around membranous tubes, when
they are inflated, would not rather conftringe the tubular cavities, and refift
diftention.
I confefs, I think it will be better to follow a third opinion, in this cafe,
which is made up, as it were, of the two others, and fuppofe that the fibres,
being contracted here and there, by an irregular influx of fpirits, and con-
flicted by a convulfion, had intercepted the natural motions of thefe tubes ;
and confequently prevented the expulfion of the copious and much-rarefied
air: and that the air, for this reafon, urging the other fibres, in thofe tracts
wherein it was confin'd, fo much the more in proportion, as it was the more
increas'd in quantity, and in power, firft overcame the refiftance of thefe
fibres, and aftewards of thofe whofe itrength had been left broken, and di-
minifh'd, by the force of the convulfion •, and by this means, at length, weak-
ening and relaxing all the fibres, univerfally dilated thefe tubes. And that the
flefhy fibres of the inteftines may be fo convulsed, as to prevent all exit to the
intercepted air, the very clofe contractions of the inteftines, which are fre-
quently met with, here and there, in diflections, plainly demonftrate.
Many obfervators tell us, " fays the celebrated Corn. Henr. Velfe ('/),"
and I have frequently feen, in bodies after death, " that when the inteftine
41 is in one part lax, foft, diftendible, and flaccid, it is in another place*
(g) Mem. de l'acad. r. des fc. a. 1713. (/) Difp. de mutuo inteft. ingrefT. p. 1. §>
(/.>) Seft. hac 21. in fchol. ad obf. 22^ 14.
" hard,.
294 Book III. Of Difeafes of the Belly.
' hard, contracted, and rugous, fo that it could not be more clofely fhut
up, and ftreighten'd by the compreffion of the hand, and would not ad-
<t
(«
mit any fluids to pais through it, but nearly refembled a lblid mafs of
*' fiefh." And after having faid that thefe coarctations " were lbmetimes
" alternate, through the whole tract of the inteftinal canal," as he faw in
the body of an infant, he proves by his own obfervation (k), which is as fol-
lows, what elaftic air, when fhut up, and more and more expanded, by rea-
fon of the heat of the place wherein it is confin'd, can effect. His words
are, " I faw in the body of a girl of two years old, a portion of the intef-
" tinum colon fo exceedingly enlarg'd, by the included air, that it refembled
" a bladder confiding of coats, which, on account of their great elongation,
M and detention, were extremely pellucid, the remaining tract of the fame
" inteftine, both above and below this tumour, being externally furrow'd by
** this very great contraction, and altogether impervious."
To this 1 would likewife have you add the equally impervious contraction,
which was feen by the excellent Bafius (/), between the upper and lower parts
of the colon, in the body of a man, which parts were greatly diftended with
air. And that when conftrictions of this kind are relax'd, as of courfe hap-
pens in thofe who are to recover from their difeafes, the fibres are now con-
lequently become very weak, under fo great a pre flu re, I have no need to
inculcate upon you : nor yet that thofe certain tracts, in which there had been
either conftriction or air, would be inftantly expanded with the whole force,
and fpring, of this elaftic fluid •, and that fo much the more, in proportion as
thefe conftrictions have been ftronger, or continu'd for a greater length of
time.
You, therefore, will not wonder, if in the obfervation of Laubius (m), the
ftomach was corrugated, but the colon diftended to fuch a degree, " that a
" very robuft and mufcular man could eafily have thruft in his whole arm,"
or that Littre (») often faw the cascum, and the colon, of the thicknefs of a
man's thigh, and that Platerus (o), even in a boy, law interlines which feem'd,
" in fome places, to be equal to" the fame thicknefs. On the contrary,
there is, at other times (p), fo very great a diftention of the ftomach, be-
yond that of the interlines, as not only to be fuppos'd to have forc'd the
contiguous part of the liver, and the diaphragm, much higher than their
natural fituation, but alfo to have prevented the defcent of the latter •, and
iometimes to have thrown the patient into fuch imminent danger, for this rea-
ibn, as to require an inftantaneous, and hitherto unthought of, remedy : fo
that an exit might be immediately contriv'd for the air, by means of thruiling
down an oblong needle, through the left hypochondrium, into the fto-
mach. But of this below {q).
However you might have obferv'd, in refpect to the woman defcrib'd by
Valfalva (>), how much the ftomach was diftended. From whence I have
taken occafion to explain the tympanites in certain cafes, not without pre-
vious convulfive conftrictions. But if you fliould choofe rather to make ufe
(i) Ibid. §. 15.
(I) Dec. 3. obf. anat. 9.
(m) Act. n. c. torn. 2. obf. 20.
(«) Mem. cit.
(o)-Seft. hac Sepulchr. 21. obf. 22. §. 4-
(j>) AA. cit. torn. I. obf. 49. cum fchol.
(?) N. 25.
(/•) N. 22.
of
Letter XXXVIII. Article 24. 295
of the explication of Littre, in all thefe cafes, I fhall be the lefs repugnant to
your determination, as in the progrcls of all we mufl, nevertheless, return to
this, if what I juft now laid be really juft and true.
24. And thus the caules of a tympanites, both after a chronic, and in an
acute difeafe, will be underttood, when the quantity of rarefied air, and its
expanfive force, fhall diftend the interlines, and ftomach, and confequently
thv abdomen, which lies in apportion therewith. But there is, alio, an-
other fpecies of tympany, when the fame air, being rarefied, on the outfide
of the cavity of thele vifcera, extends the abdomen itfelf only. And the
mufcles of the abdomen, which were even created for this purpofe, among
others-, that while every thing is in a natural flate, thefe vifcera might not be
diftended beyond meafure-, are fo far from refilling their distention, when they
are more lax than they ought to be, from any caufe whatever, that it even
appears realbnable to number them among the caules of this diftention be-
ing very confiderable, and happening very eafily. But when the air, on the
outfide of thefe vifcera, fhall urge the lax abdomen, this will be fo much the
fooner, and fo much the more, extended in proportion, as it will have no
refiflance to its force, from the parietes of the intellines and ftomach, but
only from the parietes of the abdomen itfelf.
Yet this fpecies of tympany is not frequent, either when alone, or join'd
with the former i but is even fo rare, that neither Willis (j), nor Littre ft),
have feen it : and the firfl has even laid that he could not conceive of it, and
the other that it was entirely refuted by his experiments. I, however, would
neither deny the truth of any thing, becaufe it could not be properly con-
ceiv'd of, nor would fuppofe that what does not happen in many, cannot
happen in iome : and perhaps the opinion of thefe excellent men was nearly
the fame, only not fufficiently explain'd. Yet others do not doubt, that
from humours extravafated in the belly, and there corrupted, air may difen-
gage itfelf, efpecially in thofe bodies wherein, from the effect of difeafe, it
is not well " and intimately mix'd with the humours," or, in like manner,
from any corrupted vifcus ; or finally (which is the moll eafy of all) that it
may ifTue from the intellines, which are perforated in fome part or other of
their tube.
And I faid that this method was the moil eafy, becaufe the celebrated
Haller (u) obferv'd in intellines, extremely diftended by the force of this
difeafe, that the air had made a pafiage for itfelf through their parietes, quite
into the cells which are fituated under the external coat: and, indeed, I re-,
member that the celebrated Spoeringius, in the commentaries of the Royal
Academy of Sciences in Sweden, I think, in the year 1742 (for when I wrote
this letter the book was not in my hands) has faid, that in a man, whofe in-
terline colon was full of excrements, the air had fo far expanded the cavity,
above this obflacle, that by the force exerted upon its membranes, it was no
longer contain'd in any of them, but the external ; fo that it is eafy to con-
ceive, how little yet remain'd, to prevent it from burfting forth quite into
the cavity of the belly, from that of the inteftine.
(s) («) Opufc. pathol. obf. 26.
(/) Locis indicatis a. 23.
2 Yet
296
Book III. Of Difeafes of the Belly.
Yet not only the air, but erofion alfo, or gangrene, by perforating the in-
teftines, may give an exit to the flatus, as they have more than once done,
from the llomach. Thus in the two obfervations, which are mention'd
above (x), of Camerarius, and Hoyerus, it is not at all furprizing that, as the
ftomach had been perforated, no fooner was a flight incifion made upon the
tumid abdomen, but firft of all the flatus burft forth with an explofion, and
putrid fmell. Yet that the fame thing may happen, even when the intef-
tines are not piere'd through, other obfervations fliow •, whether they are
affected with a gangrene, as in the writings of Mead (y); or whether they
incline to a gangrenous ftate, and at the fame time are externally cover'd
over with a deprav'd humour, and internally turgid with flatus, as in the
writings of the celebrated Gullman (z) •, or whether there be nothing of this
kind, except that they, and the ftomach, are both of them inflated to a very
violent degree, as obferv'd by Mercklinus (a) •, or, finally, not even this is
the cafe, but the inteftines " are juft in the fame ftate as thofe of a healthy
*' perfon," as is remark'd by the celebrated Heifter (/-).
But in thefe two cafes, and in other cafes of the fame kind, if any
other chance to occur, by what paflages fhall we fay that the air came into
the cavity of the belly ? It muft be confefs'd, that there may be fome other
different paflages, at different times, which we are not, at preienr, acquainted
with. But yet, as we, fometimes, fee certain flatulent tumours in the vif-
cera, why cannot the air be collected together, in the cavity of the belly as
it is elfewhere ? The gall-bladder, for inftance, was found very turgid with
air by Jo. Bapt. Fantonus (c), in confequence of that fluid being fhut up un-
der the external coat ; and his celebrated fon (d) has, more than once, feen, as
others have alfo, almoft innumerable little veficles of different fizes, under
the external membranes of the liver, fpleen, and, in particular, of the me-
fentery: and he conjectur'd that, as water continuing to diftill from ruptur'd
hydatids, into the belly, make an afcites, fo air burfting forth from thefe rup-
tur'd bubbles, if it does not ceafe to rufh into the abdominal cavity, upon
its feparation from the blood, will bring on a tympanites.
Yet if we even could not underftand the caufes of this effect, the effect
itfelf certainly could not be denied. For he affirms that he had feen juft the
fame thing in a young woman, as Ballonius faw in a girl (<?), I mean that the
tumefied abdomen being prick'd after death, had entirely fubfided with an
explofion. And that the fame thing as happen'd to Ballonius, had happen'd
to others alfo, and among thefe to Vallefius, you will learn from the Sepul-
chretum itfelf (f) ; and, at the fame time, who found air in the cavity of the
abdomen, when the inteftines were diftended therewith (£), or when water was
effus'd into the belly : and whom you may add to thefe you fuffkiently
perceive, from the later obfervations that I have juft now mention'd.
(*) N. 19.
(y) Monit. med. c. 8.
(z) Eph. n. c. cent. 7. obf. 89-
(a) Earund. dec 3. a. 3. obf. 142.
(b) Earund. cent. 5. obf. 84.
(<) Obf. med. 18.
75-
(d) In fchol. ad earn, ult. edit,
(e) Hie in Sepulchr. obf. 23. §. 2.
(/) Ibid. J. 1.
(g) Ibid. obf. 22. §. 4. & in additam. obf.
25. And
Letter XXXVIII. Article 25. 297
25. And left you fhculd fulpcct thefe things to have happen'd, becaule
fome inteftine was prick'd, together with the pcritonxum, as by their diftcn-
(ion they were quite in contact therewith, and become very thin in their pa-
rietes, attend to theft circumftances •, that where there was an afeites at the
lame time, water was, of courle, intcrpos'd betwixt the peritoneum, and in-
tellines •, and that where there was no alcites, it would be difficult to be done,
without fome marks or" a perforation in the inteftine being diicover'd then, or
afterwards •, none of which, when it happen'd to me, at any time, to oblerve
the fame thing, I could find out, by the mod accurate attention. To this
add, that many of the oblervations, in the Sepulchrctum (i), will teach us,
and reafon itfelf will confirm, that upon (lightly perforating an inteftine, the
air, indeed, which is neareft to the foramen, burfts out, but that the air which
is at aditlance, and diftends the remainder of the inteftines, either does nor
immediately come out, or if it does foon iffue forth, does not, however, el-
cape with fuch celerity, that the fubfiding of the whole belly fliould leem
to be the confequence, in one inftant of time, in the fame manner as hap-
pens in the explofion of a bladder ; and as, from the due confideration of the
words of thofe great men, whom I juft now commended (k), you will rea-
dily acknowledge that it was feen to do by them.
Or if you do not grant this, and will, abfolutely, contend that at the verv
point of time, in which any inteftine is (lightly punctur'd, all the air ruflies
out of the inteftines •, tell me then, I befeech you, how it could happen, that
Gullmannus (/) faw them, foon after, turgid with flatus, or how that Merck-
linus (m) (after the air had burft forth from the abdomen, when but (lightly
punctur'd, and this " had immediately fubfided) faw, on examining the
" vifcera, the ftomach, together with all the inteftines, immenfely diftended
" with air, like the mod inflated bladder."
To this add the obfervation given by Heifter («), in order " to decide this
controverfy. In a woman who " had the abdomen extremely diftended, and
" who died fuddenly," the fame thing happen'd which I have faid was ken
by Mercklin, " as foon as ever a very fmall wound had perforated the
" peritonaeum -," but the inteftines were not found to be expanded with air -,
and this was even the body, in which " the inteftines were juft in the fame
" ftate, as thofe of a healthy perfon. I will not here fay, that if they had
been previoufly diftended, to fuch a degree, by the included flatus, fome of
them would certainly have retain'd the marks of this diftention, whether you
confider'd their thicknefs or their fituation. But this one thing I will fay,
that as fo many phyficians, and furgeons, of Amfterdam were prefent, and
amongft them that very great anatomift Ruyfch, befides Heiiter himfelf,
who was a young man indeed, but even then excellent in the fame art, I can-
not be perfuaded to believe, that if any thing, beyond the peritonaeum, had
been cut into, fome one or other of them would not have immediately found
it out.
I fuppofe you fcarcely expect here, that in thefe, and other obfervations of
this kind, macTe by the moft celebrated authors, another fufpicion fhould be
(/) Obf. 75. cit. & obf. 22. §. 2. & caet. (I)
(k) N. 24. ad fin. (>«) N. eocl,
(«) Ibid.
Vol. II. Q_q ob-
298 Book III. Of the Difeafes of the Belly.
obviated, I mean that the air with which the abdomen was diftended, had,
at length, been extravafated into the cavity of the belly after death •, for the
tumour of the belly, in thofe we fpeak of, had exiiled long before, while
they were living. And that thofe veficles fill'd with air, which I have taken
notice of with Fantonus (0), might even exift in the living bodies, the flatulent
external tumours, which are acknowledg'd by mod furgeons, in the fcrotum
of dtfeas'd bodies, while living, and in other parts, and were formerly num-
ber'd by Gorgeas, among umbilical hernias, as you will read in Celfus (/>),
will fufficiently teach us.
h does not eicape me, what doubt there may be in the laft place. But I
do not at all doubt, that from a fmall quantity of humour, ftagnating be-
twixt coats, a great quantity of rarefied air may ibmetimes extricate itfelf :
and when I refided at Venice, either every thing deceiv'd me, and -not only
me, but the moft experiene'd furgeons, and phyficians, or a tumour, which
was not narrow in its circular circumference, and had form'd itfelf under tiie
common integuments of the abdomen, in a certain barber, and which I after-
wards faw perfectly heal'd, was made by included air. Nor do I eafily fee
how I could explain thofe tumours, which that celebrated man, Daniel Hoff-
man (q), obferv'd, in the day time, in a certain lying-in-woman, running about
under the very furface of the abdomen, of various fizes, and dilating them-
felves with a noife, but difappearing about evening, and that for fome weeks
together. But I know for a certainty, that the inflation which the younger
du Verney (r) faw in the laft diforder of a girl, increafing with an undu-
lating appearance, till it at length occupied the whole trunk of the bo-
dy, and, as you prefs'd it, giving the fenfation of air, as it were, under the
finger, moving away with a kind of crackling ■, this, I fay, I know, for a cer-
tainty, to have been from air expanding itfelf under the ikin •, for fcarcely was
the Ikin of the abdomen cut into, but an intolerable ftench burft forth, and
thus the whole tumour vanifh'd.
Yet I would have you, as to what relates to windy tumours, read over
thofe things that are publilh'd on their production, by Littre, in the hiftory
of the Royal Academy of Sciences at Paris (s). And in the commentaries
of the fame academy (*), you will find fome things propos'd by the younger
du Verney, in order to diftinguifh the fecond fpecies of tympany, which is
fometimes join'd with an afcites ; and, at the fame time, to prevent us either
from pronouncing a tumour of the abdomen to be an afcites, rather than the
iirft fpecies of tympany, on account of fome fimilitude of fluctuation ; or, on
the other hand, from denying it to be an afcites, becaufe there is no fenfe of
fluctuation : and fome of our obfervations may, alio, ferve to make you cau-
tious in this refpect (u). And that very excellent phyfician Werlhofius (x)
has given fome ufeful hints on thefe fubjects, fhowing how the tympanites,
efpecially when it has become inveterate, does not exclude a fenfe of weight.
But in regard to the method of cure, when you read that a tympanitical
inflation of the abdomen, which bad already ccntinu'd eight years, was re-
(0) Ibid. (>) A. 1 7 14.
(/>) De medic. I. 7. c. 14. (1) A. 1703.
(q) Conimerc. litter, a. 1737. hebd. 11. («) N. 30.
fc-) Mem.de Pacad. r. des ic. a. 1704. (*) Commerc. litter, a. 1735. hebd. 3^ ■* 4*
mov'd,.
Letter XXXVIII. Article 25. 299
mbv'd, merely by taking away a large quantity of blood, from the foot, by
the celebrated Michael Adolphus (t), who confefTes " that it was not from
" tlatus," you will judge, from what then, it did arife. And how difficult
it is to cure either fpecies of the tympanites, that is really flatulent, nothing
more clearly (hows than the remedy, which men of eminence have been un-
der a necefiky of deviling, I mean the paracentefis. But not one of the more
cautious furgeons has yet been found, that I know of, who was willing to
thrult a perforating inftrument into the abdomen, without knowing what
parts he might wound. In the number of thefe cautious furgeons he certainly
was not, who, having formerly mifhken a tympany for an alcites, and having
under the infpection of Van Helmont (z), who was then a young man, per-
forated the abdomen, in vain expected the exit of the waters. For " having
" withdrawn the trocar, the abdomen immediately fubfided, and the oatient
" perifh'd foon after: and the flatus, which was difcharg'd, was exceedingly
" offenfive, and of a cadaverous fmell." And although, the body of the
patient was not differed after death, yet nothing can more eafily happen,
than that upon drawing out the needle, the air rufhing forth, may fome-
times bring on a flight alleviation j but then nothing can more eafily hap-
pen, likewife, than that, foon after, other things, alfo, may come out of the
inteftines, and flowing down into the belly, fpeedily bring on a fatal diforder
in the vifcera.
And what will you fay to this ? That the needle might be fix'd into that
part of the inteftine, wherein, though there was fuppos'd to be the greateft
quantity of air, on account of the very great diftention, yet there was, in
fact, the leaft •, for a great quantity of air is not always in the inteftines of
tympanitic patients, and but little matter, and this for the moft part vifcid,
as it happen'd to Littre (a) to obferve. For the younger du Verney (£), on
the other hand, found the inteftines half full of matter : and the celebrated
Leonhardus Hurterus (c), having wonder'd that in a tympanitic boy, the
large inteftines, in particular, were fo diftended, that the colon had diflodg'd
the liver, in fome meafure, from its ufual fituation, and driven it to the left
fide, found, within the cavity, a fufficient quantity of matter, to produce
this effect •, this matter being very thick, fpumefcent, and of a white co-
lour, degenerating to yellow : which is a circumftance chiefly to be con-
jectur'd, in a diforder that is attended with a coftivenefs, when the patients
have either taken in a great quantity of food, before the diforder began, or
have gone on to take it in a confiderable quantity, after it has begun.
But what danger there might be in perforating the abdomen, in order to
cure the other fpecies of tympany, if the firft fpecies fhould happen to be
join'd with it, or the firft fhould be taken for the fecond ; and it is very dif-
ficult to diftinguifh one from the other j you underftand from thofe things
which have been juft now laid.
Yet of this, and of the general method of cure, in a tympany, and of dif-
(/) Aft. n. c. torn, i.obf. 244. (b) A. 1703.
(x) Ignot. hydrop. n. 44. (<•) Eph. n. c. cent. 1 & 2. obf. 184.
(a) Mem. de l'acad. r. des fc. a, 1713.
Ct.q 2 tinguifh-
Book III. Of Difeafes of the Belly.
* one fpecics from the other, as far as it is in the power of con-
s to do, and of the nature, and caufes of this difeafe, I would have
read what the celebrated Zeviani (d) has learnedly, ingeniouily, and
ikilfully written ; for if, from his very great regard, and friendfhip, 10 me,
lie would have thefe writings appear in my name, foch as it is, he had been
able to fend them to me, before this letter was difpatch'd to you, fome things
would not have been wanting herein, which, in the prefent ca!c, have efcaped
me. You will, therefore, turn to them in his writings. For 1 now go on
to add to the many obfervations of dropfy, which I have defcrib'd from Val-
ialva, fome of my own, but not a great number, left this letter mould grow
out into an enormous length.
26. A certain man labour'd under an afcites, but dill more under an ana-
farca ; and this feem'd to be the more confiderable, becaufe, as it did not oc-
cupy the face, which was emaciated, and the remainder of the head, the
other limbs, efpecially the lower, feem'd to have, when compar'd with the
head, a moft monftrous magnitude. This man dying in the ho'pital of incu-
rables at Bologna, in the year 1704, if I rightly remember, I directed him
rather in order to enquire into the nature of the anafarca, than of the afcites.
And I made my enquiries in the thighs, and the fcrotum, for the legs began
to be putrefied. The cuticle of the thighs was here and there rais'd up
into bladders, by the water which lay underneath it : one of them was of the
bignefs of my fift. Having cut quite down to the bone, I examin'd the fec-
tions, and found that the adipofe membrane was much thicken'd •, and that
the cellulae malpighianse thereof, were fill'd with a watery fat, or rather with,
water, in the chief part of them, which, by reafon of the great number of
fmall membranes of the cells lying betwixt, refembled a jelly, as I have faid
in the Adverfaria (<?). And as the adipofe membrane is propagated, not only
betwixt the mufcles, but alfo betwixt the falciculi of fibres of which the
mufcles are made up, fo in all thefe places was the water likewife propagated,
having the fame gelatinous appearance. Nor did 1 meet with any other ap-
pearance upon cutting into the fcrotum, which was extremely tumid. For
the cells, in particular, of which the dartos is compos'd, as they are con-
tinu'd from the adipofe membrane, were diftended with water. The water
therefore iftued from thefe, and all thofe other fections, and if you pleas'd
might even be eafily prefs'd out; but not entirely; for fome confiderable
quantity remain'd betwixt the little membranes of the cells.
Wherefore, transferring the knife to the abdomen, although I found fcarcely
any water between the integuments thereof, yet I did not believe that it had
fo foon flowed down through the fections of the fcrotum, and thighs ; but I
rather thought that by the large quantity of waters which fill'd the belly, and
diitended the abdomen, the water was fore'd out of the integuments of this
cavity, which would otherwife have ftagnated there, and carried down into
the lower limbs; and this while the patient was living: or if you choofe ra-
ther to confider it fo, when it was about to afcend from thefe limbs, it was
not admitted betwixt thofe integuments by reafon of the fame prefiure there-
38;
{d) Del flato, &c. 1. 2. c. 28. & 1. X. c. 27. (/) II. animad. 16.
on
Letter XXXVIII. Article 27, 28, 29. 301
on from the waters beneath, that I mention'd juft now. But in what (late
the vifccra of the belly were, I did not accurately remark ; for, as I Paid be-
fore, I did not at that time propofe making this enquiry.
27. You fee then, that the leat and eaule of the tumour, which is made
by the anafarca, are not only under the fkin in the adipofe membrane, but
alio in all the appendages of that membrane, efpecially where the fwclling
is confidtrabie •, lo that as, befides this membrane itlelf, thefe appendages are
likewife diftended, and that not only betwixt the external mufcles, and thole
that lie beneath them, but even betwixt the fafciculi of the fibres of thefe
mufcles, a large tumour is confequently generated. You fee, at the fame
time, what it is that frequently impofes upon obfervers, by the appearance of
a jelly ; for the fame little membranes, lying betwixt the portions of pingue-
dinous oil, are the reafon of its appearing lefs fluid, in found and healthy
bodies, than it really is in the living body.
Yet I would not deny that, either by reafon of the remains of this oil be-
ing interposal, or becaufe the confin'd water is very vifcid, or becaufe by
flagnation, and the feafon of the year, it becomes pretty thick, there is,
foraetimes, fomething befides thefe membranes which offers that appearance to.
our eyes. That the laft fuppofition was the only one approv'd by Glaferus, you
will learn even from the Sepulchretum (f) ; though others feem rather to have
prefer'd that which I prefer, and among thefe Peyerus (g) and Wepfer {h).
28. In diffecVing an old woman who had died of an afcites, though not a
very confiderable one, in the hofpital at Padua, about the end of the year
17 1 6, I obferv'd thefe things.
The belly, when the water was all exhaufled from its cavity, fhow'd the
liver to be befet, inwardly and outwardly, with many white, but not very
hard, tumours •, and in the pancreas was one fimilar tumour, but harder, and
much more large, as it occupied all that part of this vifcus, by which it is
connected to theinteftinum duodenum. The proper membrane of one of the.
kidnies (for I did not examine the other) was become much thicken'd, and
was eafily drawn off by the hand : the little tubuli, or fmall canals, were,
a!fo, much thicker than ufual, and for that reafon much more evident.
The uterus was notdifeafed internally. But externally, it fhow'd, in one fide,,
a confpicuous cicatrix, as if from a wound, whereas there was none in the
fkin of the belly : and on the oppofite fide, not far from the cervix, it protube-
rated into a roundifh tumour ; which being cut afunder, together with the pa-
ries of the fundus, that lay beneath it, and in great tneafure inclos'd it, ex-
hibited a fubflance of a red colour, inclining to livid, and yet not harder than
the other part of the uterus. In the tefles were thick, white bladders, which,
contain'd nothing in their cavity: but one, which was much larger, contain'd
a watery humour.
The thorax was found, except that it had fome water extravafated in it,
but not in great quantity. The brain was in a natural flate, firm, and had
not the leaft water contain'd therein.
29. There was fufrkient caufe, not to fpeak of other things at prefent, in
the pancreas, and liver, not only that the chyle and blood fhould not be pre-
(f) Sefl. hac 21. obf. 21. & fchol. Ih) Ibid. obf. 17. §. c,
{&\ Ibid. obf. 3. §. 1. & fchol.
par'd;
302 Book III. Of Difeafes of the Belly.
par'd, agreeably to the intention of nature, but alfo that the motion of the
lymph and blood mould be retarded in the belly.
It once happen'd to me, that when I walk'd into the country for the fake
of refreshing air, and meditation, I met with a flock of fheep, out of which
the butchers were buying fome at a very equitable, and others at a very low
price. When I enquired into the reafon of this difference, thefe, faid they,
for which we give the higher price, are found, but the others have a hard
liver, and water in the belly. As the belly was not more tumid in the one
than in the other, and no other mark of difeafe appear'd, that I could ob-
ferve, I fhould have fuppoied that they had not fpoken from real knowledge, if I
had not been convinc'd, foon after, from feeing ibme of thefe unfound iheep
kill'd and opcn'd. And they had made ufe of this mark to judge by. Lift-
ing up the upper eye-lid of the fheep, and attending to the colour of the
parts, that lie about the eye, they diftinguifh'd the found fheep by the red
colour, and the morbid by the white : thus, as the other part of the body is
cover'd with hairs, they examin'd the parts which were not cloth'd therewith,
juft as phyficians do the face ; and that with fo much the more advantage, as
a greater number of veffels, and thofe which are very confpicuous, lying in
that part, more clearly fliow what the nature of the blood is.
I fhould not have related thefe things to you, if I had not lately feen that
Boerhaave (z) refers to the very fame mark, and exprefsly transfers it from
the brute creature to the human •, fo as to afTert, that by the pallid colour of
the tunica adnata, and the caruncle of the eye, " a watery cacochymia is fio--
nincd •" and as we know from this fign, " that there is a deficiency of red
" blood, that all the diforders are prefent which are the confequents of fuch a
" defect." At leafl many of thefe may be prefent, or follow not lono-
after.
So among the fheep, that I have faid were infpected by me, at that time,
there was one, which, although it had no better a liver than the reft, nor
was lefs dropfical, was neverthelefs very fat, the fat being white and folid,
and the omentum very fine. That is to fay, the diforder in this fheep was
very recent : but if it had liv'd fo long as the others had done, under the in-
fluence of this diforder, it would not have been furnifh'd with fo fine an omen-
tum, and fo good an appearance of fat. For in fuch a habit of body, frefn
diforders are continually added to the firft ; as you may fee even in the bo-
dies of men, to which I return : for in the defection of fuch bodies, the vif-
cera, for the moft part, are fo much the more difeas'd, in proportion as they
have been longer macerated by the dropfy, or by the diforders that precede
the dropfy. I will give an inftance of each cafe : and firft of the fecond.
30. Cafpar Lombria, a Venetian nobleman •, of a bilious temperament, as
the manner of fpeaking is, of a large and robuft body, and, for that reafon,
fo much the more carelefs of all medical precepts, in every method of life ; af-
ter having pafs'd his fortieth year, was feiz'd with a long diforder which ap-
pear'd in different fhapes, and having made ufe of cooling liquors, during
this difeafe, to an immoderate degree, efcaped from it indeed, but with his
belly fomewhat more tumid than natural. Yet this being remov'd by the
(/) Prseleft. ad inflit. §. 863.
help
Letter XXXVIL Article 30. 303
help of remedies, he had no fymptom that deferv'd any great attention, till a
kind of diarrhoea began to affect him, and return at intervals, fometimes with
conliderable violence.
By thefe discharges the thirft, which was, at other times, almoft natural
to him, was increas'd •, and his mine, which he us'd to make in large quanti-
ties, grew very laturated in its colour, and very much diminifh'd in its quan-
tity. Yet his ltrength was not at all injur'd hereby, till about the latter end
of the winter of the year 1722, which was the forty-feventh year of his age,
when he was troubled with the diarrhoea for almoft a whole month together ;
a matter of various colours being difcharg'd, and for the mod part crude,
luous, and frothy : whereas it us'd, before, only to hold him for eight or
ten days, in which time he difcharg'd a great quantity of yellow and
fluid matter.
This diarrhoea being overcome by the help of proper remedies, return'd,
foon after, even more violently, by the neglect of regularity in living. Again:
was this diforder remov'd ; when a tremor, with which he had been flightly
affected from his infancy, and which after that firfl: illnefs became very mani-
left through his whole body, and was now and then made more violent from
the inteftinal fluxes, began to be attended with ibme new difordcrs of the heaci.
The phyficians having, for a long time, forbid the ufe of generous wines,
on account of this tremor ; though their orders ought to have been more
punctually obey'd •, and having permitted him to lofe a fmall quantity of
blood, on account of thefe new diforders, they faw, on the upper part of it,
after concretion, a cruft, which was, in one half of it, of a green colour. Yet
by making uie of a proper method of cure, his ftrength, colour, and appetite
for food, feem'd to be reitor'd, and he made water in a very proper quantity,
when the patient began to be tir'd of the medical regimen, which had been
of fo much advantage to him, and would make no farther ufe of it after the
thirtieth day. Nor was it that he omitted* thefe remedies only, but he had
violent commotions of mind, and great exercifes of body. And thefe were
fucceeded, within fifteen days after the omiflion of his medicines, by the be-
ginning of a fatal difeafe. His abdomen, which, before, us'd often to fwell
with a great quantity of flatus, but to be redue'd foon after, began now to be
tenle, with a continual, and very uneai'y tumour •, and when ftruck with the
hand, to refound like a drum : his feet were alfo a little fwollen : his urine
was of a very high colour, and in very Anall quantity : his thirft was very
trouble fome.
Thefe things being obferv'd in the latter end of May, and Michelotti, who
had begun to ufe all his art againft this tympanites in vain, being oblig'd
to fet out for France, before the middle of June, with the Venetian ambafla-
dors, earneftly recommended the patient to me, as he was coming to Pa-
dua at the fame time •, fo that if I could not conftantly fee him, together with
his phyfician, I might, at leaft, when other occupations fufrer'd me, frequently
ailnt him by my advice. J however, not yet having ken the patient, only,
from attentively reading thofe fymptoms that I have deicrib'd to you briefly,
conjecturing that there was a difeafe in ibme of the vifcera, in others a weak-
eels, defpair'd of curing him: nor did I conceal this from his relations, who
very well knew that for the fpace of feven years paft, he had icarcely ever
been.
304 Book III. Of Difeafes of the Belly.
been without a difeafe •, and upon my enquiry confirm'd that which is faid in
the latter end of the books de Morbis^ " that he had fallen into this difeafe,
** when his body had been melted down by another."
Therefore, I faid exprefsly the fame thing to them, that is immediately
added there : " if then the patient has been fuddenly feiz'd with this difeafe,
" there is no doubt but he will die in confequence of his having been fo
<c long afflicted with another." Nor was my opinion at all different, after hav-
ing feen the patient : and into this opinion, after that, came all the phyfi-
cians who were the moft eminent, at this time, in Padua. For although flatus
having been fometimes difcharg'd both above and below, the abdomen re-
founded no more if you ftruck it with your hand, yet the fwelling thereof, and
the other fymptoms that have been mention'd, were fo far from decreafmg, that
they were even increas'd every day, whatever method of cure he was put into ;
fo that the patient did not feem, now, to have brought hither a tympany,
but a fpeedily-increafing afcites, to which a dropfy of the thorax, and, final-
ly, a dropfy of the brain was added, as you will know from thofe fymptoms
that I fhall fubjoin.
In the firft place, if laying your left hand on the fide of the abdomen, you
ftruck the oppofite fide with fmall, but repeated, ftrokes of your right hand,
you perceiv'd the fluctuation of the water ftnking againft the left hand. Yet
after a few days, the belly was not only full of water, but immoderately tumid,
and by its diftenron gave refiftance to the hand which endeavour'd to make
an imprefiion upon it: and, at the fame time, not only the feet, and legs, had
an cedematous fwelling, but the thighs, alfo, were very turgid, the face, and
the upper limbs, becoming quite emaciated. In the beginning he had a
kind of cough, and afterwards none : but although the patient could at firft
lie on which fide he pleas'd, he could lie, afterwards, only on the right: and
although he could lie down in his bed, through the whole courfe of the dif-
eafe, yet twice, before the laft weeks, he was compell'd to leap out of bed,
by a fenfe of fuffocation coming on, which went away as fuddenly as it had
come.
At length, on the laft ten days he was, for the moft part, affected with a
kind of fleep, and frequently with a little delirium, but only fuch as was very
flight. Then, alio, the force of the heart, which had for a long time been
very ftrong, began to be very weak, at times : but the ftrength of the other
mufcles did not fail, even almoft to the laft. If you except two fevers, which
had attack'd him many days before death ; the firft not without long fhiverings
and tremblings, which however ended within two days •, and the fecond more
flight, and more fhort •, I fay, if you except the time of thofe fevers, the
pulfe difcover'd nothing preternatural, except that frequently, and, parti-
cularly, about the evening, it was found to be pretty quick, and his flefh
pretty hot.
In the beginning, there was a very troublefome fenfation in the epigaftri-
um, and even a pain betwixt the enfiform cartilage, and the navel-, which,
afterwards, was not perceiv'd in that part, but here and there throughout the
belly : and a fenfe of pricking remain'd in the region of the liver. His fleep,
and appetite for food, which in the beginning had been moderate, were often
deficient in the progrefs of the difeafe : and his thirft was (till more and more
violent.
Letter XXXVIII. Article 30. 305
violent. The inteftines, fpontaneoufly, difcharg'd a great quantity of mat-
ter, which was, for the mod part, fluid and yellow 5 >\ni\ fometimes the
ftools were of a different colour, and vilcid. On the other hand, the urine
was always in very fmall quantity, of a flame-colour, and fat united. As
the patient, the relations, and the phyficians, delir'd nothing more ear-
neftly, than that the urine fhould be difcharg'd more freely, I can hardly
fay how many different remedies he took for this purpofe. I believe there
was no medicine whatever, whether weak, or powerful, fimple, or com-
pound, which comes from any of the three kingdoms, to fpeak in the man-
ner of naturalifts, that was fuppos'd to have any tendency of this kind, bur
was propos'd by one or other phyfician out of fuch a number, and taken by
the patient.
But all were of no effect, as generally happens where nature, itfelf, does
not co-operate with the phyfician ; for his urine was never, in the leaft, in-
creas'd in its quantity, or chang'd in its appearance, except that about fif-
teen days before death, and again, on the laft days of his life, it dcpofitecl
a little quantity of fomething, of a tobacco colour, in the bottom of the
veflel ; which, upon diligent examination, I found to be blood mix'd with
ichor, and this I demonftrated to thole whom it concern'd, that they might,
at length, put fome ftop to the ufe of diuretics. Some of thefe, but at a
time that was lefs inconvenient, and fuch as were lefs to be fufpected, I had
alfo recommended, not with the hope of curing, but left the patient fhould
perceive that I defpair'd of his cafe, and among thefe fome of the turpentine
kind.
But as I obferv'd that the urine had not gain'ti even that violet odour,
which it generally does from the ufe of thefe remedies, I diftrufted them,
and even the pafiage of the kidnies ftill more than before ; and thought it
was better to return to the inteftinal paflages, efpecially as the medicine
call'd purified tartar, which we us'd at intervals, caus'd a confiderable dis-
charge, and often a very watery one, without any inconvenience, and always
brought on an alleviation of fome hours, from a troublefome kind of fenfa-
tion, which was perceiv'd at the region of the ftomach. Yet even this me-
thod was of no advantage.
The patient had heard, from Michellotti, that the urine of a heifer had
fucceeded with him, more than once, in the cure of an anafarca. As he
was, therefore, defirous of trying, though neither the time of the year, nor
fome other circumftances of this kind, were fuch as L'emery (k) would
have prefer'd, yet I indulg'd him in the ufe of a remedy, of the fame kind
as " the urine of fheep, or the urine of affes-," which, as I had read in Avi-
cenna (/), were formerly recommended, by fome phyfician-:, againft this dif-
eafe ; and which, finally, not only difcharges the water of patients in an
afcites, by the kidnies, but alfo by the inteftines, as the obfervations of
L'emery inform us : I indulg'd him, however, with this reftricTion, that he
mould not drink more than feven ounces on the firft day, and fhould add two
ounces every day afterwards. And on the firft day, he felt an 'effect which
L'emery has not taken notice of, in the recital of others.
(i) Mem. del'Acad. r. des fc. a. 1707. (I) Canon. 1. 3. Fen. 14. tr. 4. c. 13.
Vol. II. R r For
306 Book III. Of Difeafes of the Belly.
For a little after he had taken it, his head was affected with a kind of
drunkennefs, which, however, went off foon afterwards, and did not return
on the following days, although a greater quantity was taken. On the fifth
day, the patient went io far as thirteen ounces, yet did not make more water,
Jjut difcharg'd a greater quantity by ftool, fo that, on this very day, he dif-
charg'd water to the quantity of four or five pints, without any lofs of
ftrength : yet was no other kind of relief obferv'd therefrom, than what had
been obferv'd from the tartar-, the belly not being at all lefs fwell'd, and the
lower limbs even becoming more tumid. For which reafon this remedy
was then intermitted. Some time after, the patient would return to the fame.
He drank every day, fucceflively, for five days together, eight ounces.
But found it of no more fervice than before : and indeed, upon being at-
tack'd by the fecond fever, which I fpoke of above, was oblig'd entirely to
omit it.
In vain alfo ; and I wifh I could fay without injury, in a difeafe, which it
was much more eafy to increafe, than diminifh ; in vain, I fay, did he ufe
other remedies of the fame kind, whether they were taken in by the mouth,
or in the form of glyfters, or lay'd upon the abdomen. For when a certain
fenior phyfician had order'd the juices of dwarf-elder, and wormwood, to
be applied to the belly, it had no effect, but to bring on a fruitlefs defire
of going to ftool, and an itching of the fkin about the region of the liver,
where the fmall veins appear'd livid. He therefore gave up the ufe of
thefe juices, nor did he find any application to the abdomen of ufe, if the
pains of the belly at any time required to be affwag'd, but the omentum of a.
weather-fheep fmear'd over with the oils of violets, wormwood, and almonds.
But this was more early in the difeafe. Now let us go on to the end of the
diforder and the difiection. He died like a fuffocated perfon, with his face
and fhoulders very livid : but water and blood came out of the mouth and
noftrils of the body after death.
The body was diffected the day after, which was on the third of Auguft,
in the year before mention'd, in order to be embalm'd. The upper limbs
were mark'd with a kind of livid petechiae. And from the lower limbs, an
cedematous tumour was produe'd through the back, quite to the fcapulae.
The belly contain'd a quantity of foetid water, of a green colour inclining
to yellow, with which the parietes were diftended to their utmoft capacity.
In this water, fwam fome pieces of purulent fubftance, which I fuppos'd to
have come from the omentum, though they feem'd to be mucilaginous. The
ftomach, and the inteitines,. which were fcarcely at all turgid, were of a black
colour, as the mefentery was alfo. The liver was hard, internally, and ex-
ternally confiding of tubercles, that is of glandular lobules, which were
very evident, and evidently diftinct from each other : yet it was not larger
than its natural fize. But the fpleen was large, and of a compact fubftance,.
ar.d, when cut into, difcharg'd net the leaft blood. One of the kidnies con-
tain'd ichor in its pelvis.
In the thorax, and particularly on the right fide, was a great quantity o£
water, of the fame kind with that in the belly. So in the pericardium alfos
in which, however, there was no great quantity. The lungs were turgid
and
Letter XXXVIII. Article 31. 307
and blackifh in their colour. The heart was without blood, not to fay with-
out polypous concretions.
The head, as the body was embalm'd, in order to be carried no farther
than Venice, to be laid in the family vault, it was not ncceflary for us to
open ; nor, indeed, were we at liberty to do it.
31. Since the time that Joannes Poithius, as you have it here in the Sepul-
chretum (m), found the fu.bftance of the liver, in an afcites, " univerlally
*' granulated internally, the granules appearing every where like peas,
*' both as to figure, and number," many other fimilar obfervations have
been made upon the fame difeafe. Four others are extant in the fame place,
one of Wepfer's f»), to whom the liver " appear'd like a body conglome-
M rated of a great number of glands," a fecond of Ruy fell's (o), a third of
Brown's (p), a fourth of Hartmann's (q), to whom the fame vifcus feem'd
to confift, in the whole of it, merely of large glands," or " of glands," or
" of lobules." And the fmalleft parts of the liver cannot be fo enlarg'd, but
they muft be injurious to the function of this vifcus, and much retard the
motion of the blood through the belly •, either by comprefling the other
parts which lie between them, or, at leaft, by comprefling the fanguiferous
veflels.
Wherefore Pofthius, and Brown, in vain drew off" the water, which would
be frequently refupplied, when " the liver was difeas'd," as Erafiftratus ad-
monifh'd in the works of Celfus (r). For as to what Celfus replies thereto,
*' that when the water was drawn off there was room made for remedies,"
to bring back the liver to a found ftate, this difeafe of the liver is certainly
not of fuch a nature, as to admit of medicine. And although this appears
only by diffection, yet there are fo many difeafes, both of this and the other
vifcera, which do not admit of a cure, that when there are fymptoms of the
vifcera being injur'd, we muft not run, heedlefly, to prefcribe the evacuation
of the waters. For which reafon, in the cafe of this noble patient, of whom
I have been fpeaking, no one, out of fuch a number of phyficians, ever
propos'd it.
But as to what many, in conjunction with Ballonius fj), and our Sancto-
rius (t)> are afraid of, left the inflammation of the peritonasum, inteftines,
and a gangrene, fliould be the confequence of evacuating the waters, they
may feem to fear it with great juftice, to thofe who read over the examples
of cafes, wherein the water. was drawn off, many of which are related in the
Sepulchretum (u). And to thefe you will, in the firft place, add that fa-
mous inftance, which the celebrated Scherbius (x) has defcrib'd, of a man,
in whom a calculus form'd in the receptaculum chyli, and oppofing itfelf to
the quick afcent of the chyle, and of the lymph, into the ductus thoracicus,
had brought on an afcites of fuch a kind, that the water was drawn off by
(«) S. 21. obf. 4. $. 21. (/) Ibid.
(«) Obf. 32. («) Obf. cit. & 2. Sc 4. §. 1 ; & 6. §. i. &
(o) In additam. obf. 34. it.; & 11. §. 1. & in additam. obf. 49. & 64.
(/>) Obf. 49. & 76. & 86.
(?) Obf. 50. (x) De calculo receptac. chyli. hydr. caula.
(r) De medic. 1. 3. c. 21.
(/) In fchoL ad §. 1. obf. 5. hujus feft. Se-
pulchr.
R r 2 the
308 Book III. Of Difeafes of the Belly.
the furgeon ieven different times •, as frefh fluids were always collected, till,
fixteen hours after the lad evacuation, the patient ceas'd to live. And al-
though this dropfy, as you plainly fee, had not its origin from any taint of
the vifcera, yet the " omentum was found to be almoft universally con-
" fum'd ; and the other vifcera were befet with a gangrene: nor is it to be
" wonder'd at," fays Scherbius, " fince, in procefs of time, the fame is to be
" feen in all dropfical bodies."
But the love of truth does not fuffer me to conceal what mav, on the
other hand, be faid in favour of the paracentefis •, as thefe lafr. words, them-
felves, do not altogether run counter to its ufe, but even, if you rightly at-
tend to them, recommend it. Not to enquire, therefore, whether that is
always the effect of the water being difcharg'd, and of the air getting in at
the orifice, with what inftrument foever, in whatever manner, or how many-
times foever, this operation may be perform'd ; which the diffection of drop-
Heal bodies frequently fhows to be the effect of the diforder itfelf, as in thefe
bodies the inteftines are often found to be of a black colour, as they were in
the patient here fpoken of, though the waters had never been drawn off by
paracentefis j certainly a great number of cures, that have been fuccefsfully
perform'd in this method, will fpeak in its defence, and diffections will alfo
argue for its ufe, as they have frequently made it evident, in patients who
have died from other caufes, that " the inteftines were in a very good con-
dition, and that in the abdomen, not to fay in the peritonaeum, where it had
been perforated, " there was no trace of inflammation, and much lefs of
" fphacelated corruption, to ufe the words of Polycarp Schacherus (y)> who
gives us the diffedtion of a virgin, that had been long troubled with an
afcites, and had died " on the eighth day after the operation" of the para-
centefis, which had been many times perform'd upon her.
32. But the inftances of this method of cure being fuccefsful, are fo rare
among us, or, at leaft, were fo rare, that during all the time I ftaid at Bo-
logna, I never heard one phyfician fay that he had feen it fo ; at which time,
likewife, I faw there, and heard from every body, that the operations of
this kind, which were perform'd by foreign furgeons, and thefe men of emi-
nence, were unfuccefsful. And indeed I remember that Albertini, on com-
paring the phthifis, and the dropfy, with each other, faid that the former had.
been three times cur'd by him, though in a confirm'd ftate ; but that the dropfy
of the abdomen, when confirm'd, he had, to that very day, never cur'd.
For if the water, faid he, is evacuated by the furgeon, I fee that the pa-
tient dies : and if it be ftrongly urg'd, by the phyfician, to the renal, or
inteftinal paffages, the medicines which force it to thefe paffages, do not fo
much difcharge that which is extravafated in the belly, as the ferum which
(till remains in the blood ; and do not force it more into thofe paffages, than,
into the belly, where an entrance is already made for it. Thus he told me,
it had lately happen'd to a man of eminence, in particular, who having taken
remedies of this kind from an empiric, had his urine indeed increas'd there-
by, but had the fwelling of the abdomen fo much increas'd at the fame
time, that fcarcely any blood could be found in the blood-veffels after
death.
(y) Difl'. fupra ad n. 3. cit.
Yet
Letter XXXVIII. Article 33. 309
Yet he did not conceal the furprizing cures of patients labouring under
an afcites, whereof he had heard, or read ; five of which were even reported
to have happen'd at Bologna, from a puncture of the fcrotum. But as he (up-
pos'd that (omc had labour'd under an analarca, rather than an afcites, others
under an afcites, but one that was not yet confirm'd, and fome under a
dropfy of the peritonaeum, he did not, in fact, leave many behind-, and the
cure of thefe was owing to nature rather, as he thought, than to art. And,
indeed, the power of nature in curing this, and other diforders, is fome-
times very confiderable.
It happen'd in the place of my nativity, that a noble youth being feiz'd,
once and again, with an ardent fever, and drinking a great quantity of wa-
ter, both in his firft and fecond illnefs, they were each of them lucceeded by a
very confiderable afcites, which was carried off, both times, by a fpontaneous
difcharge of a great quantity of water j fpontaneous, I fay, for this was com-
monly known, and the phyfician of the patient affirm'd it to me, who cer-
tainly would not have, unjuftly, detracted from the honour Of his own cures.
Without doubt, nature had lufficiently unlock'd, for herfelf, the paftages
by which £he might reabforb the fluid ftagnating in the belly, and fend it to
another part of the body ; and thefe were the fame which fhe made ufe of,
in that merchant fpoken of by Mead (z), when fhe took up again into the
veffels, and retain'd there, all the waters which were extravafated in the belly :
and that in one night only, and in the very night which preceded the day,
intended for drawing them off, by perforating the abdomen. But when the
fame nature, neither of herfelf, nor when excited by gentle invitations, or
fomewhat more acrid ftimuli, attempts any thing for her own relief, muft we
attempt any thing violent, and dangerous, and contrary to her difpofitions ?
Or muft we rather make ufe of the paracentefis, where all circumftances
permit it, which is a remedy, as we may fuppofe, firft pointed out by the
fame nature herfelf?
33. For as to the navel being open'd by the great force, and diftention, of
the water, and the afcites being cur'd by the difcharge thereof, I do not fup-
pofe this to have been firft feen by Benivenius, and others whom Donatus
(a), and Gabelchoverus (£), quote, but by men of antiquity formerly; and
thefe perfons, alfo, have remark'd that they, in whom the water was dif-
charg'd altogether, died ; but that fome of thofe, in whom it came out
gradually, and at different times, recover'd. Phyficians, therefore, might,
according to their general rule, imitate nature, when fhe operates rightly : and
Hippocrates (c), and after him Celfus (d), advis'd not to let all the water be
difcharg'd at one time ; for that this was fatal : the caufes of which have
been explain'd by many learned men, in our prefent age, and among thefe
by the younger du Verney (e), by Werlhofius (f), and Mead (g) ; but more
copioufly by the illuftrious Senac (b).
(z) Monit. med. c. 8. in fin. (d) De medic. 1. 2. c. 8.
(«) De med. hid. mirab. 1. 4. c. 21. (e) Mem. de l'acad. r. des fc. a. 1703.
(b) Sett, hac Sepulchr. in fchol. ad §. 1. (f) Commerc. litter, a. 1735. hebd. 37. n.2.
ebf. 6. (gj C. 8. fupra ad n. 32. cit.
(<:) Sefl. 6. aph.27. (b) Traite du coeur 1. 4. ch. 12. n. 3.
The
310 Book III. Of Difeafes of the Belly.
The explications of thefe gentlemen feem alfo to be confirm'd by that ob-
fervation (;'J, in which all the matter was drawn out without any fwooning
being the confequence ; but fo flowly, and gradually, by reafon of its tenacity,
that almoft three hours were fpent in the operation : and this will feem lels
furprizing to you, when you have learn'd from the celebrated Targioni (&),
that there was a dropfical perlbn, who had his belly fill'd with fo denfe a
jelly, that it could not be drawn out by any art of the moft experienc'd fur-
geon. But nothing has more confirm'd thefe explications, than the method
which was happily thought of, in conformity thereto, of drawing off all the
water at one time, without any injury •, that is to fay, by binding the abdo-
men with rollers, not only after the water was difcharg'd, which du Verney
(/), whom I juft now quoted, order'd after a plentiful difcharge, but alfo
while it is (till more and more drawn off, and then in particular.
By this method, he who firft invented, and applied it, I mean that ex-
cellent phyfician Mead (m), mentions that many perfons, but a woman, in
particular, was cur'd under his care, who had all the water difcharg'd " at
" once," to the quantity of " fixty" pounds weight; and that another had
her life perferv'd, for the fpace of fix years and feven months, from whom,
through the whole progrefs of her difeafe, water was taken away in fuch a
quantity as, if the hiftory were not well known to every body at London,
would be incredible, that is " a thoufand nine hundred and twenty pints."
But with how much caution thefe operations are to be undertaken, and per-
form'd, thofe eminent furgeons among the Englifh, that he mentions, have
fhown : although he even knew a dropfical woman, who furviv'd after the
abdomen had burft of itfelf, and difcharg'd a great quantity of water; a
fimilar cafe to which you will read the defcription of by Nebelius (n). In
both of thefe inftances the abdomen being over diftended had crack'd near
the navel.
Other obfervations are, moreover, extant of waters fpontaneoufly burfling
out at the navel itfelf, with a happy event; but fcarcely ever of all burfling
out together : and thefe, not only produc'd by thofe whom I mention'd above,
but by others (o) alfo. Yet phyficians have not gone on to open the navel,
in order to cure the afcites, as fome of them were influenc'd by contrary ob-
fervations, and moft of them taught by experience, that in proportion as the
abdomen is more eafily extenuated there, by the diftention of the water,
with fo much the more difficulty does the wound heal up afterwards, which
frequently happens ; and that it is ftop'd up with lels convenience at prefent,
in order to prevent more water being difcharg'd, than the ftrength of the pa-
tient could bear ; and, finally, that all of it could not poffibly be drawn
off, without the patient being oblig'd to lie on his belly, which is a pofture
very inconvenient in fuch cafes.
For as to its being better to difcharge the water by the navel, becaufe,
by thefe means, the umbilical vein being openM, the watery humour would
not be pour'd out from the liver thereby, into the belly, but would be
(/') Commerc. litter, n. 1745. hebd. 52. n. 3. (m) C. 8. cit.
(A) Prima raccolta di oflerv. nied. («) Eph. n. c. dec. 3. a. 9. & 10. cbk 122.
11) Mem. cit. (») Aft. n. c. torn. 8. obf. 79.
thrown
Letter XXXVIII. Article 34. 31 r
thrown out of the body ; this was an opinion which, having taken its rife
lately from hypothecs, and from the opinion of lome perfons that Aviceniu
makes mention of (p), has icem'd, at lalt, to be confirm'd by fome obferva-
tions. For there have been, as you fee here in the Sepulchretum (q), thole
who have laid that this vein, which had been already long contracted into a
ligament, being foften'd by the continual maceration of the waters, was
again open'd, and that it then dik harg'd the fuperfluous water from the
liver, by the navel •, and that they had found it fo dilated, at this time, as to
admit a catheter, and a goolc-quil : and that it was very full of water, and
contain'd a confiderable quantity.
I, however, although l fliould be willing to grant, that it may be kept
open in fome, as it is from the original formation, rather than fuppole it
could be eafily open'd again, after being condens'd into a ligament * and
though I cannot agree with Schultzius (r), who has averted that after the
birth it is drawn up to the liver, from the navel, fo as not to go thither any
more ; yet it would not then, by any means, appear, how it fhould take up
ferum only, from the finus of the vena portarum, and leave the blood be-
hind. And this I do not fay, fo much on account of Platerus, and Hilda-
nus, as on account of Rolfinc, who is more modern than either of them.
Yet I do not deny their obfervations ; and only fufpedt that they did not
find the umbilical vein, but merely the theca, to be open and full of water ;.
with which theca, from the duplicature of the peritonaeum, this vein is in-
creas'd in its bulk. For in dropfical bodies the membranes are eafiiy relax'd :
and the vacuity betwixt them is fill'd with the redundant water. And,
this fufpicion of mine is ftrengthen'd by an obfervation, which is not
Riolan's, as Rolfinc thought, but is neverthelefs extant in his works (s).
The umbilical vein, fay* he, " was found to be fiftular in a certain dropfical
" woman, and through that, water was pour'd out betwixt the peritonaeum,.
" and the abdominal mufcles."
But now let us fubjoin the cafe of a very long dropfy, as I have pro-
mis'd (l).
34. A virgin of twenty years of age, having had no appearance of the
menftrual difcharges, for two years before, was firft attack'd with pains ia
the hypochondria ; after which her belly began to be tumid. She had been
afflicted with this tumour for about a year, and had us'd various remedies
to no purpofe, when Pnc was receiv'd into this hofpital of Padua. The bulk
of the iwelling was extremely large : yet this patient could lie down in bed
for the whole month fhe was there, even to the laft ; but fhe lay, for the moll
part, on her left fide. She was thirfty, but not to a great degree ; unlefs
when a flight fever, with which fhe was conftantly troubled, increas'd. She
difcharg'd but a lmall quantity of urine : yet it was not very high-colour'd.
She now and then complain'd of thofe pains in the hypochondria, that I
have already fpoken of, which feem*d to be convulfive, but not very vio-
lent. Many remedies were made ufe of, but without the lead advantage :
the quantity of her urine was never increas'd. Among thefe remedies were
(p) Traft. fupra ad n. 3c. cit. c. 5. (s) Anthropogr. 1. 2-. c. \z,
fame?
{q) Obf. 13. cum fchol. & obf. 14. (/) N. 29. "iiffin,
[r) Difl". de vafis urr.bilic. nator k adulter.
3i Book III. Of Difcafes of the Belly.
jfome tilings which created an uneafinefs, as gum ammonicum, and turpentine :
for which reafon they were omitted.
At length, when the belly, from being coftive, was become pretty lax,
foetid, and liquid, ftools began to be difcharg'd, but not purulent. As the
difcharge of this matter continu'd, the belly did not decreaie, and her
strength was every day broken more and more, that happen'd which is fore-
told of a dropfical perfon, in the latter end of the fourth book de morbis :
** but where the inteftines are alfo very lax he dies very foon, with the
" power of his fenfes and his fpeech quite perfect." Her fenfes, therefore,
continuing to the laft, fhe died about the middle of December, in the year
1744. Having this relation made to me on the following day, and having
made it known to a very crowded audience, and foretelling fome of the
appearances which were foon after found under their eyes, the diffection was
immediately begun in their prefence.
The body was emaciated, particularly in its upper limbs, but not to a
great degree. The inferior limbs were affected with fo flight an oedematous
tumour, that you could fcarcely diftinguifh it, but by preffing them with
your finger : and this did not reach quite to the top of the thighs. The
belly was very large, but not tenfc ; nor yet the navel, although it was pro-
minent.
The abdomen being perforated at one fide, a great quantity of water was
gradually difcharg'd, which left the fame fenfation upon the hands, as a lixi-
vium pour'd upon them would have done. That which firft flow'd out was
yellowifh, and thin •, the other lei's thin, and almoft white. But when I ex-
amin'd both of them, after being left, for twenty-four hours, in a very large
veffel, the whole of it feem'd to be whitifh •, yet when it was pour'd our,
by degrees, from one veffel to another, it appear'd to be rather yellowifh :
nor had much whitifh humour, fubfided to the bottom, in proportion to the
quantity of water. What had fubfided, however, was pretty thick, from little
pieces of the omentum being mix'd with it, and other things of which I fhall
fpeak hereafter.
However, neither the water, nor the body, had a putrid fmell, notwith-
standing the fmall inteftines had begun to grow black in three places, though
not beyond the breadth of an inch in each place. The greater part of thofe
inteftines were tumid with air, but in not great quantity. The large in-
teftines, as well as the ftomach, were altogether empty, and collaps'd. The
whole of the omentum (if you except a fmall part of it which remain'd, and
adher'd to the ftomach) was torn into pieces, as it were; and not only entirely
leparated from the remaining part of its fubftance, but from each other alfo :
one of which had form'd itfclf into a round, red, and foft body, nearly of
the length of a man's forearm.
The liver, on its whole convex furface, and even at its anterior border,
coher'd with the diaphragram : and when divided from thence, feem'd to
have that furface more protuberating, than was agreeable to the liver itfelf,
and to the ftature of the virgin, which was rather inclin'd to fmallnefs. When
cut into, I found it every where, except in the lobulus Spigelii, fomewhat
more pallid, and harder, than was natural : and the bile, which was in its
veficle,
Letter XXXVIII. Article 34. 313
•veficle, in fmall quantity, of a yellow colour inclin'd to brownifli, turbid
and vil'cid.
The fpleen, except that its lizc was preternaturally increas'd, was inter-
nally (bund : as a fecond fplecn alio was, which was Id's by many degrees
than the former (its diameter being only an inch in extent) of a round ifti
figure, and adher'd among the veflels, being connected to the larger fplecn,
by membranes, and in the. neighbourhood of it, but entirely disjoin'd in its
fubftance, though exactly of the fame ftructure internally, and of the fame co-
lour. But in the coat of the larger fpleen, befide fome hydatids, little
bodies of a roundifh figure, white, hard, and of different fizes, were pro-
minent : yet molt of them were iomewhat bigger than millet feeds.
The lame appearances were obierv'd, here and there, on the interior fur-
face of the peritonaeum, and on the exterior of the interlines, especially of
the fmall ones, in which, likewife, were hydatids. The largeft of thefe was
equal to the fize of a fmall apple, and of two inches in diameter; the l'an-
guiferous veflels from the interline, producing themfelvcs through the
membrane thereof, and dividing into branches. In it was contain'd water
almoft colourlefs, but in part mucous. The pancreas was hardifh. And
the mefenteric glands, which were fo increas'd beyond their natural fize, as
almoft to fill the whole mefentery, were perfectly fcirrhous •, as their hardnefs
and whitenefs demonstrated.
Yet I met with the chief and peculiar diforder in the teftes, the tubes, and
the uterus itlelf: which was not difcover'd in the uterus, without direction •,
but in the teftes, and the tubes, came fpontaneoufiy into view. For thefe
parts had, equally on both fides, together with the alas vefpertilionum, fo
coalefc'd one with another, and, being much thicken'd, had fo grown into
a kind of tuberous, and fhapelefs mafs, of a confiderable fize, that one
could not, by any means, be known from the other, and much left ie-
parated. The furface of each of thefe malTes was lacerated, for a consi-
derable fpace, and was found to be fpontaneoufiy open, juft as if a large
fteatoma had burft itlelf. And to this 1 compar'd it, becaufe it confifted of
a matter, which refembled nothing more than half-dried fuet : fo white was
it; of fo unctuous a nature if you handled it; and fo eafily yielding to the
probe when pufh'd into it. If you pull'd it afunder, you perceiv'd that it
confifted of fo many fmall pieces, as it were. And it was quite inodorous.
As the parts, which I have mention'd, feem'd to be converted into a
kind of fuet, fo when I cut pretty deeply into the fundus of the uterus, which
was found externally, and in the greater part of its parietes, I faw that the
remaining internal part of the fubftance, of thefe parietes, was converted
into a matter which was fimilar to that juft now defcrib'd ; except that, in
its colour, it inclin'd fomewhat to the cineritious hue. And with the lame
matter the cavity of the fundus was fill'd ; and from that the part which was
lead folid, feem'd to have been accuftom'd to fall through the cervix, into
the vagina, which was even now whitilh, from the remains of this very
matter, that could eafily be wip'd oft". However, the cervix, both internal-
ly, and externally, was perfectly found : and the magnitude of ir, and of
the fundus, alfo, was not greater than was to be expected, in a virgin of
fuch an age ; except that the internal orifice of the uterus feem'd to be fome-
what larger than ufual.
Vol. II. S f The
314 Book III. Of Difeafes of the Belly.
The other parts of the belly, and the kidnies in particular, were found. Yet
the trunk of the great artery appear'd to be of a lefs latitude than it ought to
be. And the diaphragm afcended pretty high into the thorax, but much the
moft on the right fide ; whither it was fore'd, as I have faid, by the protube-
rance of the liver. When we took this vifcus away from the diaphragm,
by cutting through the vena cava, fome considerable quantity of blood flow'd
from it, of a black colour, and not coagulated.
The lungs Were every where, very clofely, connected to all the parietes of
the thorax, that is to the inferior parietes alfo. The upper part or rhe left
lobe was, in one place, fomewhat harder than is natural, yet not evidently
difeas'd. In the pericardium was a great quantity of water, of the fame
kind with that in the belly. The heart was lax ; and in this, and the great
veffels, was only little blood, which was black indeed, but lefs fluid than that
in the inferior vena cava, although without any polypous concretion.
While the head was cut off from the neck, a little water flow'd down,
both' from the cavity of the vertebras, and of the cranium. And the lateral
ventricles of the brain contain'd water in no very fmall quantity, of a brown-
ifh colour and turbid : the plexus 'choroides were in great meafure pallid.
Yet the cerebrum was pretty firm, notwithstanding the cerebellum was very
fcfc.
35. There are many things in the obfervation in queftion, which, if I
were to confider them feparately, would make this letter far more prolix
than the preceding. You will perceive this from what I fhall fay of hydatids
only. For although that rare diforder of the uterus very well deferves to be
treated of, yet I fhall have a more convenient opportunity of fpeaking of it, in
other letters, and perhaps in the next («) •, for, certainly, this was not the
proximate caufe of the dropfy of which we are to treat at prefent, as the rup-
tur'd hydatids feem to me to have been. For, as on the external furfaceof the
interlines, and the fpleen, fome hydatids were prominent, which had not
yet burft afunder; fo I fuppofe that there had been almoft innumerable
others, both in thefe, and in other parts, which having been ruptur'd long
before, had pour'd out their fluid into the cavity of the belly. And, not to
detain you with, many words, the obfervations which I have very frequently
made upon the tunica albuginea, and vaginalis of the tefticles (x)^ induce
me to believe that the membranous laminae of the hydatids, or of the coats
in which they are form'd, after they have by rupture pour'd out the fluid
that they contain'd, fir ft contract themfelves, and their veffels, into the form
of a caruncle; and unlefs a frefh fluid continue to flow thither, are finally fo
indurated, and dried up, as to reprefent thofe white and hard tubercles of a
roundifh figure, fome larger in their fize, and fome lefs, as the hydatids had
been, with which the internal furface of the peritonaeum, in the virgin de-
fcrib'd, and the production of it through the external furface of the fpleen,
and inteflines, were befet.
You may read, in the Sepulchretum (y), an obfervation of Jacobus Wolf-
fius, where he fays, that in the body of a woman, who had labour'd under
(«) Epift. 39. n. 36. {j) In additam. ad hanc fe&ion. 21. obf.
(.r) Vid. cpiit. 43. a, 1.6. Scfeq. 6.5.
c an
Letter XXXVIII. Article 35. 315
an afcites, " caruncles, which, when open'd, difcharg'd an ichor, adher\I>
** in fevcral places, to the intellincs." Read what is produe'd from Uil-
gerus (z), of another woman, who had an afcites, " that the whole of the
" inteftines, on all fides, and the peritonaeum, on both fides, about the
" diaphragm, were Bll'd with many thouland little granules, in the fame
manner that fometimes happens to hogs. Join to thefe the obfervations af-
terwards publifh'd, which were taken irom other droplical bodies ; as, for
inftance, that of the celebrated Anhornius (a), who faw the peritoneum, in
a young man, " belet with glandular knots, which wept a limpid water, if
" prefs'd," and, in a woman, haying, " here and there, many glandular
" tubercles, protuberant in the (hape of a bean, fome larger, and iome
*' fmailer, in their fize, which, when prels'd, wept a lympid water ;" and,
in like manner, thofe of the celebrated Stegmannus (/»), and Goetzius (c), the
firft of whom obferv'd the pancreas, in a man, to be fprinkled with millet-feed,
" as it were," and the latter, in a virgin, various tubercles of different
" magnitudes, growing here and there" (to a fac in which a fluid had been
contain'd) " varying from the fize of a large pea to that of the fmalleft
" hemp-feed, fometimes folitary, fometimes in clufters, but always fcirrhous,
" and hard, and, when cut afunder, difcharging no fluid, or gelatinous
" matter."
Finally, read over again what I have formerly written to you (J), of hard
granules, or tubercles, being prominent on the internal furface of the peri-
tonaeum, or pleura ;, as water was even then extravafated in the great cavities,
which thofe membranes furround : you will certainly find the fcries of
fucceffive changes that I have defcrib'd. It happen'd, fome years ago, that
in a woman, who had been taken off by an alcites, the external coat of the
inteftines was found to be diftinguifh'd with very frequent tubercles. Part
of the fmall inteftines was brought me, that I might judge what thefe
tubercles were. When I firft examin'd them they refembled fmall turgid lenti-
cular glands : but they were without an orifice, and folid, and feem'd to be
made up neither of glandular, nor of a flefhy fubftance, but to be of a mid-
dle nature, as it were, betwixt both. I judg'd that I could determine upon
nothing more probable, in regard to them, than to fuppofe that they were
the remains of ruptur'd hydatids, contracted into themfelves, but not to lb
great a degree, at prefent, as to be diy and hard.
Nor was I deter'd by lb very great a number of hydatids, as there muft
neceflarily have been to agree with this fuppofirion ; fince I very well re-
member'd the almoft innumerable quantity, which Coiterus (e) formerly
found in a profeflbr at Bologna. His words are, " to the mefentery, peri-
" tonaeum, inteftines, fpleen, liver, and, finally, to all the vifecra, veficles
*' of an unequal magnitude, and thefe full of limpid water, adher'd." And
not to lead you too far from the obfervations of other ancient authors, and
even not to lead you from the Sepulchretum, wherein that of Coiterus is not
entirely omitted (f), confider that Fhilippus Perfius (g) found, in a woman,
(z) Seft. ead. obf. 20. §. 16. (d) Epift. 16. n. 30. & epiil. 22. n. 18.
(a) Eph. n. c. cent. 9. obf. ico. n. 2. & 7. (e) Obf. anat.
(6) Earund. dec. 3.3. 5 & 6. obf. 168. (f) Sett, hac 21. obf. 21. §. 8.
(cj Act. n. c. torn. z. obf. 20S. (g) Ibid. §. 5.
5 f 2 who
316 Book III. Of Difeafcs of the Belly.
who like our virgin had fallen into a dropfy from a fuppreflion of the men-
fes, " the kidnies, uterus, ftomach, inteftines, heart, pericardium, liver,
4; and fpleen, abounding (for the number of them exceeded nine hundred)"
with pendulous veficles of this kind : and, in like manner, that Mauritius
Cordaeus (b) found in another woman, all the parts internally, and others,
" cover'd, and loaded, on their external furfaces, with thefe pendulous cyfts,"
of different fizes, and forms, " being fill'd with a citron-colour'd fluid, and,
at leaft, exceeding the number of eight-hundred •, not to fpeak of a third, as
the fluid was not yet extravafated into the belly, who being fuppos'd to be
pregnant, had " the whole body internally, the epiploon, mefentery, liver,
jpJeen, lungs, the heart itfelf alio, and the peritonaeum, befet with veficles,
full of the mod limpid water," from the obfervation of Ballonius (/').
$6. You fee, therefore, that the parts which, in the virgin whofe hiftory
I have given, were rough with tubercles, have been, in other dropfical
bodies, befet very thickly with hydatids-, as the inteftines, the fpleen, and the
peritonaeum. And indeed the laft-mention'd part is fometimes cover'd with
ib great a number, that it " fcarcely comes into view," as Ruyfch (k) found
it, and reprefented in a figure-, or is refolv'd into filaments, and veficles full
of water, as Paawius (/) found it to be refolv'd, in the cavity of the belly,
together with the omentum, both of them being wanting, in their natural
fituations.
But the omentum, although it is a production of the peritonaeum, juft in
the fame manner as the external coat of the fpleen, and the inteftines, and
hydatids are frequently form'd therein alio, and that not uncommonly, as
many obfervations fhow, among thefe that of Bofchius (m)t Malpighi («),
Vallalva (0), Goektlius (p), yet it is of fo tender a ftructure, that it cannot
often confine them, for a long time, within its laminae : wherefore they ge-
nerally fooner burft afunderpn their increafe, and, at the fame time, tear
afunder, and deftroy it : and this I confider as one of the principal caufes,
why, in patients who have an aicites, the omentum, for the moft part, as
happen'd to the virgin in queftion, by no means remains found. And from
hence Hippocrates, I fuppofe, took occafion to fay (^), " that they, whofe
" liver, being full of water, has difcharg'd itfelf upon the omentum, have
M their belly fill'd with water."
For he who, in brute animals, faw hydatids, of the lungs, as I have taken
notice of to you on a former occafion (rj, obferv'd thofe appearances, alfo,
in them which I juft now fpoke of, that is to fay, fometimes, hydatids of the
omentum, but more frequently that erofion which Galen requir'd (s) ; and
brought the water down from the neighbouring liver, into the omentum, as
from the vifcus, " moft apt," as Galen fays, " to generate hydatids, in the
" membrane that furrounds it externally ;" inafmuch as " the liver feems,.
*' fometimes, even in animals that are kill'd without difeafe, to be full of
{b) Ibid. §. 14. (e) Supra n. 4.
(/') Sepulchr. J. 3. f. 37. obf. 3. f. 12. (p) Eph. n. c. cent. 6. obf. 94.
(A) Thef. 7. n. 37. & tab. 2. f. 3. (y) S. 7. aph. 55.
(/) Sepulchr. f. hac. 21. obi". 3. § 8. (r) Epift. 16. n. 33.
(m) Ibid. obf. 21. §. 2. ($) Comment, in aphor. cit.
(n) Exeic. de omento.
" them."
Letter XXXVIII. Article 37. 317
" them." And phyficians, fince it has been cuftomary to diflefl human
bodies, have not only confirm'd the obfervations of the ancient preceptors in
medicine, taken from beads, by the inlpection of human bodies ; but have alio
retain'd their hypothecs of the caufe of the dropfy, often to be dedue'd from
water being pour'd out of ruptur'd vcficukv, in whatever vifcus thefe
may be luppos'd to exiit : although even afterwards, they have, every now
and then, return'd to brute animals, if they might happen to fee fome things
which relate to the examination of hydatids more clearly : and that this has
not even been neglected by me, as far as was in my power, you will perceive
from what I fhall fubjoin.
37. Among the number of the largeft hydatids, that certainly was one, which
Caldefi (/) faw in the liver of an ox : for the whole weigh'd nine pounds-, and
the coats, by themfelves, fixteen ounces. And as thefe coats were three in
number, each of them, in general, confided of many other lamina;, were robud,
and flefhy •, but the external coat, in particular, more than the others, firm,
mufcular, ami confiding of fibres very much entangl'd with each other :
whereas the internal was very weak and thin : and the middle coat, which
was of a golden colour, and rugous, had fome pieces of gypfeous, or rather
of bony matter, affix'd to it. The water which was comprehended within.
thefe coats, being of a limpid appearance, and faltifh in its tafte, was not in.
the lead chang'd, by the mixture of different liquors with it : nor yet did.
it coagulate by boiling, any more than the liquor of other hydatids, on which,
he had made this experiment in vain.
If with this ftrudture which I have defcrib'd, you compare that which
Cordaeus («) obferv'd, in fo many bladders feen by him, (for Perfius (x) has
nothing in regard to the ftructure, nor yet Ballonius (y), except that he re-
marked " a triple coat" on each of them) you will eafily perceive, of how.
much advantage to Caldefi, the magnitude of his hydatid was. For Cordseus
only faw the following things, " that they, were made up of two membranes,
" the internal very white in its colour, the other very fimilar to the coat of
" the domach, yet ibmewhat thinner, but perfectly of the fame colour
" therewith." To me however, although it cannot be doubted, but that
fome of the appearances which Caldefi faw, were peculiar to that hydatid;,
it has never yet happen'd to light on any fo large as I would have wifh'd:
and when I have lit on any, I have not been able to examine them,
otherwife than externally. Yet, even in this manner, have I remarked fome
things, which, perhaps, are not unworthy of our diligent inquiry, in others
of the fame nature. .
I formerly faw one in a calf, of fifteen days old, which was round in iti
figure, offixorfeven inches in diameter, hanging from the flat, and upper,,
part of the liver, into which, in fome meafure, it fubfided ; being, clofely
fix'd thereto, to the extent of two or three inches : and from this part to
which it was fix'd, did it receive its blood-vefiels, but mod of them in fuch
a manner, that, as I retain it firmly in my memory, I fhall relate it to you.
For as I could fee, through the membrane of that hydatid (which, in other
reflects, as I perceiv'd by taking hold of it, betwixt my fingers, was not
CO Oflervaz. int. alle Tartarughe. (x)
(a) 5 (y) Supra ad n. 35.
VTCf
318 Book III. Of Difeafes of the Belly.
very thin) not only the water that it contain'd, which was of a greenifh co-
lour, flightly inclining to yellow, but even (as this water was pellucid) what-
ever fwam therein-, To fome fmall trunks of veflels feem'd to be carried from
the liver, through the middle of the cavity of the veficle, which, after hav-
ing reach'd to the oppofite part thereof, were reflected upon the external fur-
face of it, and being divided into larger, and fmalier ramifications, made a
kind of beautiful net-work.
But, although I faw this net-work, and thofe ramifications of blood-veflels
very plainly, and undoubtedly, and very flender ftrJBE of fat, as it were, at-
tending upon them •, yet as I faw thofe included, and floating trunks, which
ftris of the fame kind feem'd to accompany, only through the fubftance of
the traniparent membrane, I beg'd of thofe who fhow'd me ihis hydatid,
that they would fuffer me to open it ; but in vain, as they faid they were
willing to fliow it to fome other perfons, to whom they had jufl: before pro-
mis'd the inflection. And from them, (who either did not properly attend
to the included trunks, or did not well obferve what would follow from that
pafTage thereof through the cavity of the veficle) I could get no other in-
formation, than that the water was of a faltiih tafte, and did not at all coagu-
late on the fire.
Not long after this in the calf, I faw another hydatid, lefs indeed than
that, for it was not bigger than a hen's egg, yet confidering the proportion of
the animal wherein I found it, much larger. This animal was an old hen-
pigeon, which even at this time lay'd eggs, and, though feemingly very
healthy, was found fuddenly dead in her neft. As no caufe of this unex-
pected death appear'd externally, upon examining internally, I found the
brain, the lungs, and the heart, to be found, and without any mark of
difeafe •, except that the ventricles of the brain were entirely empty, and the
heart itfelf without blood-, when, at length, going on to the liver, 1 perceiv'd
the caufe of this laft appearance, and of the fudclen death.
For the liver was fomewhat livid in general, and, on the upper part, al-
moft black, and lbfter than natural •, and a large blood-vcflcl having been
ruptur'd there, a great quantity of blood had been extravaiated about this
vifcus itfelf, and the inteftines, and had coagulated. I fuppos'd the rupture
of this vefTel to have been accelerated by the pre flu re of the large hydatid,
of which I have already begun to fpeak. This hydatid had one of its extre-
mities fix'd into the internal fubftance of the ovarium -, as other lelTer hydatids
had alfo, of which I fhall fpeak prefently : and through its furface fanguife-
rous veflels were fcatter'd -, a yellowifh water being contain'd within, not
comprehended in one cavity, as far as I could judge externally, but divided
into manv cells, which were tranfparent. To the membrane itfelf, of which
the hydatid was compos'd, at the extremity that I have fpoken of, fome
very fmall vitdll were inherent, very fimiiar to the others, with which the
ovarium abounded : yet they were fomewhat harder than thefe, and inclin'd
more to whitenefs.
From the ovarium, beli.lc one pretty large egg, which was almoft ready
to fall off, fome other hydatids were pendulous, perfectly fimiiar to the one
I have already defcrib'd, except that they were about three times lefs, and
not connected immediately to the ovarium, but by means of an intervening
peduncle,
Letter XXXVIII. Artiele 38. 319
peduncle, or ftalk, of a confiderable length. Finally, then were feme Others,
110c larger than a very lmall bean, fuuated among thefc vitelli -, but thcie
much more white than the others, and full of a limpid water. Yet by boiling,
neither this water, nor the )cllowilh water of the others, coagulated : and the
eggs, which adher'd to the extremity of that largcfl hydatid, as they had been
leis iofc before boiling, were, alio, more harden'd than the others, afterwards.
J intended to have examin'd internally, the cells which I had feen through
the coats of the larger hydatids, but being cali'd away on fome occafion, gfe
fervant unieaionably diligent, who fuppos'd that I had examin'd every appear-
ance to my fatisfaciion, threw them all away, in the mean while, to a place,
from whence, though I was greatly chagrin'd at the accident, it was itn-
poflible for me to recover them.
38. Do not be furpriz'd that I was fo much difpleas'd, at not having it in
my power to examine clolely, into thofe appearances I had feen, in the calf,
and the pigeon, through the coats of the hydatids. For the hydatids which
fhow fanguiferous veiTels palling through the middle of their cavity, or this
cavity divideel into feveral cells, you cannot eafily account for, as to their
origin ; either from a fimple glandular veficle, the orifice of which has been
ftop'd up, or from fome one interftice of a lymphatic vefiel, that lies betwixt
two pair of valves, being fhut up on boih fides.
From the time that Wharton made ufe of thofe interftices of the lymphas-
ducts, to explain the formation of hydatids, in that manner which has been
transfer'd, not once only, but twice, into this fection of the Sepulchretum (2)^
he has, probably, had not fewer followers, than they who have made ufe of
the fimple gland : and there have even been fome, who, by making additions
to the hypothefis, have endeavour'd to render it more probable. The induftry
of all which authors I commend : and I even believe, that the great number of
veficles which Perfius (a) had ieen " doubled, as they are taken out in trouts,"
argue for the opinion of Wharton •, fince they refembied two interftices not yet
disjoin'd, as thofe " pellucid little cords, confifting of thin veficles, chain'd
'* together, as it were,1' many of which have been iometimes feen in the wa-
ters of patients in an afcites, by Mead (Z>), alfo do.
But, although I do not deny, that hydatids may have their origin, in fome-
certain way cr other, at one time, from a fimple gland, and, at another time,
from interftices of this kind •, yet I do not fee how they can all be accounted
for from thence. For it is long ago that Ruyfch (c) admonifrYd us, of a
great number of hydatids being found in the placenta uteri fometimes, as I
have alfo leen, and in other parts, in like manner, wherein no lymphs;ducts
are found. He therefore fuppos'd " that hydatids were the extremities of
** larrguiferous velTels, which had chang'd their former nature, and had dege-
u nerated into a difeas'd ltruclure." There are fome, alfo, who imagine, that
it a watery humour flow, not only from the injur'd parietes of the lymphse-
duffs, but from any part whatever, among the furrounding membranes, they
are confequently elevated, and form'd into hydatids. And if any one mould
thooie to illuftrate their opinion with a little accuracy, he might,, perhaps,.
(z) Schol. ad S. 8. obf. 10. & ad §. 2, obf. (£) IvJonit. med. c. 8.
2:. (<-) Adverf. dec. 1. c. 2, vid. & thef. 6. tab.
(a) Ibid. §. 6. 5. f.g. 3. & feq.
tender
320 Book III. Of the Diieafes of the Belly-
render it proper to explain, and account for, the greater part of hydatids; and
would underftand, without difficulty, from the cellular ftructure which lies
betwixt the membranes, and the fanguiferous vellels, which pafs throurm
that ftru&ure, from whence it is, that iome hydatids id) appear to be divided
into cells, and why (e) veflels are carried through the middle of the cavity
of others : to which vefTels if he mould refer thole " two (lender fibres" that
O^J~ Tyfonius (f) obferv'd in lb many hydatids, " proceeding " from one extremity
•thereof, " and fluctuating within their liquor," he would probably come much
nearer to the truth, than this author, when he conjectur'd hydatids of that
kind to be infects ; which fucking out a nourifhment for themfelves, trans-
mitted it into their belly, by thofe two little tubes as it were.
And if hydatids, that are pendulous by a long and Render ftalk, mould
chance to require an explication, 1 mean fuch hydatids as Ruyfch (g) (who has
given a figure of them (b) ) and others, and I myfelf, have often leen, parti-
cularly from the ovaria, and the neighbouring parts, of women; and not only
thofe that were pendulous from the ovarium or that pigeon ; the fame perfon
will be at liberty to fufpect that the other cells of any hydatid, being broken
off from the i'mall fanguiferous trunk, or being collaps'd, in confequence of
having pour'd out the humour they contain'd, one of the extreme cells ftill
remains connected, and flill retains its fluid. And, indeed, I have, fome-
times, very evidently feen a fmall fanguiferous veffel, palling along with the
filament, by which an hydatid of this kind was pendulous (/).
39. But there are ftill others to be attended to : and thefe of greater impor-
tance likewife, not only on account of the difeafe in the vifcera, wherein they
are generated ; but on account of the more eafy production of that difeafe,
which I am at prelent ipeaking of. Hitherto I have, in general, fpoken of
thofe that are prominent on the furface of the vifcera, or pendulous there-
from. Yet there are others which lie latent underneath, or are, at lead, not
very prominent," for the moft part ; as in the kidnies in particular. I de-
fcrib'd them formerly in the Adverfaria (£), under the title of large cells ; and
have often told you, in the courfe of thefe letters (/), that they have been feen
both by Valfalva and me.
But I have feen this appearance at other times: and not only one of them in
a fow, which was almolt as large as a nut, but alio in human bodies, and thefe
pretty large. Yet none of thefe, if you except one which I have refer'd to in a
certain oitier or liable-keeper (m\ was rais'd up beyond the furface of the kid-
ney ; not even that which was feen by Valfalva, in the body of an old man (»),
and which occupied one half of the kidney. And yet I have feen others that
were prominent, particularly in two old women ; the hiftory of one of whom
I will here relate to you, on this account merely, but in a very brief
manner.
{d) (/) Vid. cpirt. 43. n. 19.
(t;N. 37. (-0 III. animad. 33.
(f) In additam. ad hanc Scpulcltr. feci, ap- (I) Epilt. 4. n. 19. ep. 10. r. 19. ep. 17. n.
pend. ad obf. 49. 14. ep. 21. n. 15. ep. 24. n. 6. & ep. 25. n. 4,
CgJ C. 2. cir. (m) Epiil. 4. n. cit.
\k) Obf anat. chir. hg. 6$. (») F.piit. 17. n. cit.
40. An
Letter XXXVIII. Article 40, 41. 321
40. An old woman who had an incurvation of the fpine, and was lame,
died in the hofpital at Padua, after the middle of March, in the year 1747.
She had been lately brought thither, on account of a diforder of the apo-
plectic kind, which did not appear to have injur'd any other faculty, but that
of her rpeech. .ore, as the other difordcrs of the woman could not be
«rly known, and as I was then taken up in other obfervations, relative
to parts which were in their natural ilate; and even continu'd my inquiries
in reference thereto, in the body of this woman, I had but juft opportunity
to remark the following preternatural appearances.
In the belly, the trunk of the great artery began, almoft immediately, af-
ter giving off the emulgents, to dilate itfelf gradually more and more, the
more it delcended ; till, a little above the divilion, it expanded itfelf wholly
into an aneurifm, which was of two inches diameter, in every direction. From
thence it was again gradually contracted; yet in fuch a manner that the iliacs
themfelves appear'd to be much wider than they naturally, are, to a confider-
able extent. The internal furface of thefe velTels was unequal : but the in-
ternal furface of the aneurifm (till more fo •, where not only polypous concre-
tions were found, but in one part of the coats, bony concretions alfo. I mould
be inclin'd to fuppofe, that the caufe of thefe diforders of the aorta, had, in
great meafure, confifted in the diftorted figure of the fpine ; which, having a
convexity in the thorax, on the right fide, had another on the left fide, in
the loins, which carried away the aorta along with it. And for this reafon I
was lefs furpriz'd to find, in the left kidney, thofe diforders on account of
which I defcribe to you this diffection.
For from the lower extremity of that kidney, an hydatid, of the bignefs
of a fmall apple, protuberated. It was full of a redifh water, although, when
look'd at throug-h the furroundinp- coats, it feem'd to be blackim. Thefe
coats were two in number externally ; the outermoft of which was nothing elfe
but the adipofe membrane of the kidney, deprived of its fat, by the very-
emaciated ilate of the parts : the other was the proper membrane of the kid-
ney, which, not only the quantity, but alfo the weight of the included water,
in confequence of preffing from above downwards, in that fituation, had dif-
tended. Wherefore, although there were two other lefs hydatids, in other
parts of the fame kidney, they had not rais'd up that membrane beyond the
furface of the kidney ; that is to fay, they were confin'd under it, like the other
more frequent cells, and had hollow'd out a kind of bed for themfelves, in
the fubftance of the kidney. And a larger hydatid had, alfo, hollow'd out
a feat for itfelf, in the upper part of the fubftance of this vifcus, almoft in the
fhape of a hemifphere; fo that you might perceive it to be of the fame kind
with the others : the diameter of this hemifphere was equal to the breadth
of a man's thumb.
41. The difiection of another old woman you will have on another occa-
fion (0), in whom the left kidney, in like manner, but at its upper extremity,
was greatly extended into an hydatid which had form'd itfelf thereon ; as this
hydatid contain'd water, of a flight yellow colour, to the quantity of four
ounces.
(0) Epift. 60. n. 6.
Vol. II. T t To
322 Book III. Of Difeafes of the Belly.
To the larger veficles of this kind you will, without doubt, refer that
" large watry abfcefs," as Harvey (/>) call'd it, " like a hen's egg, and fill'd
" with yellow water, which had imprcfs'd an orbicular cavity" on one of the
kidnies; as there were alfo other lefler appearances, of this kind, on the ante-
rior furface of both the kidnies, of a very old man, who had died with a fup-
puflion of urine. Or, at leaft, you will refer to this clals, " a bladder like
" a large walnut, diftended with the moft limpid water, and inherent to half
" its diameter, in the fubftance of the kidney", which Doringius (q) found
in Bucrctius-, whofe fame kidney contain'd a great quantity of fand, at the
fame time that the other contain'd a calculus.
Two veficles equal to that, and fill'd with a kind of watry humour, refcm-
bling urine in colour, I remember to have found, formerly, in. the body of a
man which I dific&ed at Bologna, in the anatomical theatre, as a fubftitute
for Valfalva, in his abfence : and the pelvis of the fame kidney, in which
were thefe veficles, and three whitifli calculi, of the bignefs of vetches, was
dilated. I alfo remember that the man died with a fupprefiion of urine, in
his bladder indeed : but this was not the caule of his death •, as there were
other more confiderable difeafes, which it is not necefiary to take notice of
here (r). Thele two hydatids, however, were confin'd, as moft of them are,
under the proper membrane of the kidney. Nor do they feem to have ap--
pear'd differently, which Willis (j) afferts " had been frequently found by
" him, in hydropical bodies," where he tells us, that in the body of an illus-
trious man, there was " a large cavity in the middle of the right kidney, dif-
tinct from the pelvis, much larger than that, and fill'd with limpid water,"
and that the left kidney " contain'd many hydatids, and cavities fill'd
" with a very limpid water."
He conjectures that very fmall cavities had been firft form'd in the fubftance
of the kidnies, by ferum ftagnating in fome part of it ; which cavities were
more and more dilated, by the gradual increafe of this fluid : and doubtlefs
.you fee that " limpid, very limpid, redifh" water was found in thofe cavi-
ties. Nor indeed have I been without doubts, at feveral times (7), although
from the colour, and the odour, it more frequently feem'd to be urine, whe-
ther it was not, rather, " a fluid very fimilar to urine-," as I was not ignorant,
that the ferum of the blood is either very often, naturally, of a yellowifh colour,
or becomes fo, by its remora in the vifcera : and that the humour, found in
hydatids, is generally fo, from what caufe foever it may ariie (v.) -, and as I
obferv'd, at the fame time, that it was poflible it might contract its urinous
odour from the kidnies, wherein it is lb long retain'd : and that cavities of
this kind were every where furrounded by an internal and uniform coat; fo
that it was never in my power, or the power of any other perfon, that I
know of, to find a manifeft communication with the pelvis, or tubuli, of
the kidney.
Therefore, as to the cafe being quite different in the obfervation of Plate-
rus(^), where, on cutting afunder bladders full of water, which had form'd
(/>) Sepulchr. 1. 2. f. i. obf. 17.
(?) Ibid. 1. j.f. 14. obf. 48.
(r) Vid. epilt. 41. n. 10.
(.<) Sepulchr. 1. i.f. J3. cbf. 1.
(.') Vid. animad. fupra ad n. 39. indicat.
(a) Vid. fupra n. 35 57.
(.v) Sepulchr f. hac 21. obf. 8. $. 2.
them-
Letter XXXVIII. Article 42. $2$
themfclves upon the body of the kidney, " the water flow'd out, and the
M foramina rematn'd open jM fo that this is not to be attributed to thofe blad-
ders, but to the many ulcers, which, as he lays, had perforated the kidnies,
from the internal quite to the external parts ;" lb nothing forbids us to
fuppofe, that fome or the ulcers had opend foramina for tnemfelves, quite
to the cavity of the veficles. And by this obfervation, we may be led to fup-
pofe another manner, in which thole hydatids of the kidnies may much fooner,
and much more certainly, bring on an afcites, where there are ulcers com-
municating with the pelvis •, for thele will reach fooner to the large cavities
of thofe hydatids, than to the fur face of the kidnies: and by carrying thither
an acrid ichor, and a great quantity of urine, will burft them, and pour out
this fluid into the cavity of the belly; juft as they mull, of themfelves, have
pour'd out their contain'd liquor, in another obfervation of Platerus fjv), and
had pour'd it out in that which I have refer'd to above (z), from Picolhomi-
•nus, in conjunction with the former of Platerus.
However, even when there are no ulcers, if thefe hydatids are fo many in
number, or fo large in their fize, as to have deftroy'd, or condens'd, a great
part of the fubftance of both kidnies ; there is not the leaft doubt but adropfy
may eafily happen, by the fecretion of urine being greatly diminilh'd. But
if they, moreover, burft afundcr-, difcharge their contents-, and go on ftill to
generate a freih fluid -, it is evident that an afcites mult happen from
thence.
42. Yet if they do not continue to fecrete a fluid, but coalefce, in confe-
quence of a new fubftance of the kidney growing up around them, when
emptied, a dropfy docs not arife; the little quantity of fluid, which they had
difcharg'd, being taken up by the mouths of the ablbrbent vefTels, in the fame
manner that the fluid, with which the interior furfaces of the belly are moif-
ten'd, is abforb'd : yet in the kidney a cicatrix remains, various in its mag-
nitude, and its depth, in proportion as the ruptur'd hydatid had hollow'd out
more or lefs of the fubftance of the kidney. Read over again the twenty-
ninth letter (a), in that part where I defcrib'd, in the kidney of a woman, a
long, whitifh, and almoft tendinous line ; drawn, not only on the furface,
but alfo deeply within the very body of the kidney •, fo fimilar to the cicatrix
of an old wound, that 1 look'd for the traces of it in the neighbouring paries
of the belly, but in vain. And 1 fhall defcribeto you, in other letters, other
cicatrices of the kidnies, lefs deep, but deprefs'd ; and thefe comprehended
In the circumference of a circle : of which kind that was, which follow'd the
coalition of the larger hydatid, taken notice of in the old woman, whole
hiftory I gave you juft now {b).
From hence you jDerceive, by what method we may explain, from the ob-
fervation of hydatids, the cicatrices which are pretty frequently met with, on
the furface of the kidnies. And fuppofe that the cicatrices of other vifcera
may, alfo, be explain'd in the lame manner, when they are external, and nei-
ther wounds, nor figns of ulcers, have preceded ; as that was-, which is taken
notice of in this very letter (r), as being found in the fide of the uterus, of
( v) Ibid. obf. ii. §-4. (/-) N. 40. in fin.
C'xJ N. 19. . (C) N. 28.
{<$) N. 12.
T t 2 an
324 Book III. Of Difeafes of the Belly.
an old woman, who had labour'd under an afcites. For the uterus has alfo
its hydatids, fometimes, in fuch a number as is fuffkiently fhown by the ob-
fervations of Adolphus Occo(^), and the celebrated Adam Chriftian Thebe-
fius (c) ; and fo large in their fize, that, as I have hinted to you on a former
occafion (f)t Coiterus(^) faw one " hanging from the fide of thecollum uteri,
" bigger, to appearance, than the natural bladder, and very full of urine :"
or, as he fays, with more juftice, below, " full of thin, and tranfparent water,
" and furnilh'd, like the natural bladder, with two coats, but without any
" meatus whereby to collect, or difcharge, its contents."
But even cicatrices of this kind, both of the liver, and fpleen, as, for in-
stance, that which Haschftetterus (h) has defcrib'd, in a noble virgin (for
we muft take care we are not deceiv'd by certain fifTures, which often exift
from the original formation) fuch cicatrices, I fay, may be explain'd in a
fimilar manner. For hydatids of both thefe vifcera occur ftill more frequent-
ly, whether they are fituated quite externally, fuch as Coiterus (/') found in a
hang'd man, " under the fpleen, of the magnitude of two fills, very full of
"■• water, and feparated from the neighbouring parts, without any injury,"
or entirely hid deep in the lubflance, like thofe which are fpoken of as exift-
ing in the livtr, by Glafierus (k), Diemerbroeck (/), and others.
To which clafs, you will certainly refer the obfervation of Lyferus (m), " of
" citron-colour'd water, which burft forth in the quantity of more than three
'* pints," from the liver of a living jewefs, when pierc'd deep in its fub-
ftance ; and that obferv'd by Mauchartus, which I have already defcrib'd (;;),
and which he call'd " a dropfy of the fpleen :" and thus you will obferve,
where it happens that the vifcera are, at length, broken through, by a quan-
tity of humour internally collected, how much they increafe that dropfy,
which exifted before ; and how much thefe vifcera may feem to be corrupted,
by the ftagnant water around them, when they have been thus affected, by
the fluid they contain'd. Whether, therefore, hydatids are of this fecond
fpecies, or of the firft, or, finally, of a middle nature betwixt both, fuch as
we chiefly attend to here ; that is, ipform'd in a vifcus, as to fhew themfelves,
in fome meafure, upon the furface alfo, they are, as I faid, ftill more fre-
quent in the liver, or the fpleen.
So I faw two of this laft kind, lately, in the liver of a certain old woman,
which was, in other refpects, found, but had its anterior border of a figure
which was never feen by me before, in this part, that is falciform, about the
middle of it ; and the left lobe produc'd almoft as far downwards as the right.
Under the membrane, which cover'd the convex furface, both the hydatids,
in fome meafure, appear'd; the remainder of them being hid within the liver,
one finall, the other pretty large (o). Thus I obferv'd a great number in the
fpleen of a fow, full of an infipid, or flightly-fweetifh water. And thus in
the liver of a fecond, one of the bignefs of a cherry, not far from its edge.
{J) Sepukh. f. hac 21. obf. 55. §. 9.
(e) Eph. n. c. cent. 3 & 4. obf. 117.
(f) Epift. 16. n. 33.
(g) Obf. anat.
\b) Sepulchr. f. cit. obf. 12. §. 2.
(/') Obf. anat. cit.
(k) Sepukh. f. cit. obf. 4. §. 11.
(/) Ibid. obf. 19.
(m) Apud Bartholin, cent. 2. epift. med. 73..
(«) Epift. 36. n. 18.
(0) Vid. epift. 65. n. 8. in fin.
Yet
Letter XXXVIII. Article 43. 325
Yet in another, I found them of different fizes, and in great number-, and
not only, as in the former, half buried, but many of them even altogether
hid, within the fubfUnce : and the water of them all was comprehended in a
very thick, and white follicle.
This liver was extremelj enlarg'd, and had the whitifh net-work, by which
the lobules are intercepted, scry thick ; and, for that reafon, linking even the
inattentive eye more than ufual •, whether you examin'd it internally, or ex-
ternally. Thefe lobules were found, as the other vifcera ifeem'd to be : but
the gall-bladder was extremely contracted, and inftead of bile contain'd not
many drops of a certain mucus, which was fcarcely ting'd with any colour ;
fo as to bring back to my mind, that " almoft white colour" of the bile,
which Vefalius (p) afierts he had feen, before Diemerbroeck, and after Rim
others, who are likewife quoted in the Sepulchretum: and others fince then,
had feen inftead of bile, a humour which was " white, la&efcent, milky."
But not to digrefs from thofe hydatids of the fpleen, and the liver, of
which I was fpeaking ; perhaps you will fuppofe thole to belong to that fpe-
cies, which Hunerwolffius (q) defcribes, in human bodies, u as being innate,
" or form'd within the liver, and fpleen," befides others which he calls " ad-
V nat<e^ or form'd upon thefe vifcera," or thofe which to Horftius (r) appear'd
" to be cavities full of water, in the liver, and fpleen, of a little boy." And if
you defire to know what fymptoms had preceded in the living body, you will
read them in another obfervation of the Sepulchretum (j), in which the fame
diffection is repeated : and in fo long a fedtion, as this twenty-firft, it is lefs to
be wonder'd at, than in molt others, that it mould have happen'd more than
once//,) : for which reafon, and, at the fame time, on account of the frau-
dulent defcriptions of Blancardus, it might have been forgiven, that in the
Additamenta thofe are fet down again, as if they were new obfervations of
this author («), which Bonetus had produe'd before in this very fection (*),
and had afcrib'd to their true authors Jodonus and Parey (y) ; if, which even
Blancardus himfelf had not done (2), one obfervation of Jodonus were not
feparated into two, the twenty-ninth, and the thirtieth; or rather if from the
Scholium of Blancardus on the firft, the fecond obfervation were not made.
But the obfervation of Eggerdefus(d), which relates entirely to the thorax,
ought not to have been introdue'd here by any means, where the queflion
is of dilorders of the belly only •, or, at leaft, what is done in regard to
two obfervations (£), that, like the former, do not refer to the prefent fub-
ject, ought not to have been omitted ; I mean that notice was taken of the
obfervations being produe'd, " out of their proper place."
43. I, however, have a very different reafon for faying a few things here,
of the thoracic vifcera. For the vifcera of the belly are not the only vifcera
(p) Exam. obf. Fallop. §.7. obf. 55. §. 2. cum §.17; & §. 13. cum
(?) Sepulch. obf. 4. cit. §. 14. §. 16. et cat.
(r) In additam. ad eand. 21. fep. feci. obf. (x) Obf. 29. 32. & fortaffe alias.
82. (j) Obf. 48 & 38.
(/) Seft. ead. obf. 3. §. 12. fzj Anat. pracl. rat. obf. 84.
(/) Ibid. obf. 6. §. 7. (a) In addit. ad hanc fed. 21. obf. 61.
(u) Confer, obf. 4. §. 8. cum obf. 6. §. 12. (b) Ibid, obf, 76 & 79.
?bf. 20. §. 12. cum $. 17. obf. 21. S. 2. cum
that
26 Book III. Of Difeafes of the Belly.
that arc liable to hydatids of this kind •, and what feems to me to follow nc-
ceftarily, to cicatrices : that thefe hydatids are form'd upon the lungs, and
even upon the heart, I have already fhewn, from the obiervations of the an-
cients, the moderns, and even my own alio (c). If, therefore, any one
of thefe cicatrices which I have defin'd, occur in either of thefe vifcera, a-.
one certainly did occur to me, on the external furface of the heart of a
hare (and how frequently this fpecies of animals is attack'd with hydatids,
lufficiently appears even from the reading of Rhedi (d) alone.) What for-
bids me to account for a cicatrix, from the inanition, and coalition, of an
hydatid, in the fame part wherein I have fecn an hydatid half-buried in the
Jubilance ? Wherefore, you will, likewife, deduce the origin of cicatrices in
the thoracic vifcera, from hydatids ; as I faid in regard to the vifcera of the
belly.
And that the fecond fpecies of thefe (e) is, probably, to be acknowledged
to exift in the lungs, you will conjecture from the water collected within
them, in a kind of facs, as it were ; which was twice feen even by the illuftri-
ous Senac (f).
44. But here you certainly expect from me another explication of the ori-
gin, not of cicatrices, but of certain hydatids ; fuch, for inftance, as were
Jeen by Redi (g), in hares, not only buried, in clutters, within the fubftance
of the liver, and tied one to another, but alfo under the external coat there-
of, and of the whole alimentary canal •, and between the membranes of the
mefentery, without any cohefion therewith •, and even many that were free,
and quite unconnected, in the cavity of the belly, like animalcules, which
could move themfelves to and fro : fo that it came into his mind, as it did
into the mind of Tyfonius afterwards, as I faid above (b), to enquire whe-
ther they were certain infects, or rather embryoes of infects ; the latter of
which conjectures I fee is juftly rejected by Tyfonius •, and the firft, to omit
other considerations, does not very well agree with the experiments, which
have fhewn that the very limpid water, whereof they are full, never coagu-
lated by the application of fire. But Tyfonius •, although very fond of that
firft conjecture, not only for other reafons, but becaufe the internal coat of
his hydatids, which were taken from other animals, had no cohefion with
the external, by which it was every where furrounded-, has, ncvertheleis, CGn-
fefs'd that this external coat " was furnifh'd with blood veflels :'" and that all
hydatids are not of this kind, particularly thofe which are found in the ovaria
of dropfical women, as they are made of enlarg'd veficles (or, according to
his hypothefis, of ovula) which are natural to thefe parts ; and, in like man-
ner, thofe which he law burft forth from the right fide of a woman (who
was then labouring under diforder, but afterwards perfectly cur'd) when
open'd a little below the fpurious ribs ; burft forth, I fay, together with a
great quantity of limpid water, to the number of five hundred; they being
alfo turgid with a water of the fame kind.
(c) Epift. 16. n. 33 & 44. (f) Trnite do cocur, 1. 4 en. 3. n. 4.
(<i) Offervaz. int. agli anim. vivent. &c. . (g) Offcrvaz. cit.
W N. 43. (A) N. 38.
2 , Hydatids
Letter XXXVIII. Article 45. 327
II were after this found by I Iunerwolrfius (i ), and Hartmann (£)'
by the former in a woman, fuch as, " befides a white, gummy liquamen, con-
in'd, in themfclves, other more (lender bladders full of lymph " but by
latter, in a dog, within one and the fame membrane, which was that of
(he omentum, many were found to be comprehended together, lb that this
membrane being pull'd away, the hydatids " ruih'd forth with a flight pref-
" lure," the liquor of which did not coagulate by boiling, yet had with it
*' a kind oi' lumj" and the coat which was proper to each, being made
up of many other membrane?, was lb denfe, that, when cut afunder, it did
not collapfe ; and even felt as if it were fomewhat fat, when touch'd by the
fingers : of this fatty matter the hydatids, " when boil'd," exuded a great
quantity.
Neither were thole, by any means, connected with each other, which that
celebrated man, Alexander Camerarius (/), found in a considerable number,
containing a limpid water, and comprehended in a membranous fac, wherein
the fteatoma of a man's liver was, at the lame time, included. As I have never
yet happen'd to light on hydatids of this kind, I have chofen rather to point
out to you, here, the obfervations of others ; which you may eafily compare
together ; than attempt an explanation of thole tilings, which I had it not in
my power to examine myfelf. This has been attempted by Hartmann, in
regard to his, in the Scholium which he has added (m) ; but whether his hy-
pothefis will pleafe you, I am very much in doubt. You will rather afk,
whether there are any things in the writings of other very learned men, that
you can better approve ; and efpecially among thofe, who have writcen of
the inorganic formation of cyftic tumours, or thole who have often fpoken,
in thefe times, of veficles fwimming in the fluid of thefe tumours. *
However, although in fome hydatids I have feen, through their coats, what
I have faid above (»), and even, in a woman whom I have defcrib'd to you
in a former letter (0), have feen the thin, internal coat of the hydatids iur-
nifh'd with whitifh little veffels, and, in a fow, form'd into a kind of cells, as k
were -, yet I think that the veficles which are met with by anatomifts, and are full
of water, are not all of the fame kind, and, therefore, that the origin of diffe-
rent hydatids are to be differently explain'd : and the origin of fome not, per-
haps, in one way only, but in many join'd together. And I would have you,
in particular, read over what the celebrated Morand (p) has feen, and con-
jeclur'd, on the fubjecf. of thofe veficles, which are found in great number,
under one coat; either conneded together, or unconnected, and fwim-
ming in a fluid fimilar to that which they contain, or pour'd out into the
cavity of the belly.
45. And of this kind, in particular, I would have you fuppofe thofe vefi-
cles to be, from which Aretseus (q) has faid that a peculiar dropfy is form'J.
That is to fay, " certain very fmall veficles, in great number, full of a fluid,
(;) In additam. ad hanc Sepukhr. fcft. obf. (0) Epilt. 21. n. 47.
8-- (/) Mem. de l'acad. r. des fc. a. 1722. & hilt.
(k) Ibid. obf. 83. a. 1723.
(I) Aft. n. c. torn. 3. obf. 12c. (?) De cauf. & fign. morb, diut. 1. 2. c. x.
(») Ad cit. obf. 83. in fin.
{") N. 3;.
" and
32'S Book III. Of the Difeafes of the Belly.
" and proceeding from the place, where an afcitesis generally form'd," which
he might even fee in the human body, when the parietes of the belly were
piere'd through, in order to draw off water •, juft as Tyibnius, as I have laid (r),
faw them come forth, in great number, from another part, and as you will
read that it happen'd, in fome meafure, to Morand (s). For as to Aretaeus
adding, that there were fome, who " affirm'd bubbles of this kind to have
" pafs'd through the inteftines," into the cavity of the belly, this is the very
cafe, if I am not deceiv'd, which he denies his ever having feen •, and not
this dropfy of which he gives the fign, as Peter Petit (/) believed (in con-
junction with others) who thought, becaufe he had not leen it himfelf, that
Aretseus alfo could not have feen it.
But they who affirm'd thofe veficles to have pafs'd from the inteftines, into
the cavity of the belly, had, probably, found thofe appearances, in fome brute
animal, which I have faid to be leen by Redi(u); the relation of which being
underftood in a manner fomewhat different, as frequently happens by thofe
who had heard it, fo that thefe veficles were fuppos'd to have come from
the cavity of the inteftines, Aretjeus might be indue'd to add immediately
fuch things as had a tendency to lhow that the narration, thus underftood,
was improbable. However, the fign which he has produe'd of this dropfy,
that is to fay, when he writes thus, " if you perforate the abdomen, you
" will draw off very little water; for the veficle on the infide, prevents the
" effufion, by flopping up the orifice : but if you force your inftrument into
" the veficle, the fluid will again flow out ; fhows the infupportable diffi-
culty there is to the removal of a diforder of this kind, unlefs the veficles
mould happen to be fituated in one place, or to be fo difpos'd as they were
in the woman fpoken of by Tyfonius (x) •, and, in like manner, in the drop-
fical ruftic mention'd by Riverius (y) : although, in general, where there is
a dropfy from hydatids, or with hydatids, of whatfoever kind they may be, fo
that they are in great number, or large in their fize, the abdomen is perfo-
rated in vain.
For befides that thofe which have already burft afunder, may go on to pour
out a fluid, " the opening of one veficle," as in purfuance of the hint of Tul-
pius (z), Thomas Bartholin {a) has rightly admonifiVd, " does not evacuate
" the reft, . although they cohere, in the manner of bunches of grapes-, and
not only if they are disjoin'd one from another. Therefore, to the other
caufes why this chirurgical operation does not always anfwer, even at the time
when all other circumftances feem to be favourable, add this alfo, becaufe, to
life the words of Ruyfch (b), " as it very often happens that there are hyda-
" tids in dropfical perfons, they feldom or ever recover, if the paracentefis of
" the abdomen is perform'd." This he faid on occafion of a dropfical woman,
whofe peritonaeum, and mefentery, were both of them fill'd with hydatids.
And that this happens, very frequently, in the mefentery of perfons labour-
ing under an afcites, is demonllrated, not only by other more ancient ob-
fervations, but alfo by thofe more modern ones, contain'd in the volumes of
(r) N. 44. (y) Obf. hinc ir.d. deccrpt. 15.
(s) Mem. cit. (z) L. 2. obf. med. c. 34.
(t) Comment, in cit. locum. \a) Ad. Hafh. vol. 1. obf. 8.
(«) N. 44. (b) Thef. anat. 7. n. 37.
(*) Ibid.
2 the
Letter XXXVIII. Article 46. 329
the Caefarean Academy (*)■ But in regard to the hydatids of other parts
which are in the belly, as I have produe'd quite a fufficient quantity of examples
already, 1 will add one of the ftomach, from Jacobus Yongius (a), in that wo-
man whole wonderful cafe you cannot explain, unlels you fbould have your
eye to that caufe which we generally have an eye to, in the diabetes. For as,
through the whole courfe ot the difeafe, flic made almoft as much water as
flic drank of fluids, it does not well appear from whence the water could
proceed, two hundred and fourteen quarts whereof were difcharg'd within
eight months, by the operation of the paracentefis, which was repeated to
the nine and twentieth time, in that ipace. This woman, therefore, had a
. great number of hydatids on the ftomach, and inteftines.
46. As the observations which I have, relative to the tympanites, will
come in more conveniently on a future occafion, by reafon of the difor-
ders complicated therewith, I fhall choofe to fubjoin, in their flead, two
which relate to the dropfy of the peritonaeum ; a difeafe (to premife a few
things upon that head) which has, in fact, not been defcrib'd by the mod an-
cient authors, nor yet was fir ft fpoken of by Tulpius (*), nor Bogdanus (f)t
as they themfelves feem'd to believe, and moft authors have fuppos'd. I do
not fay this, becaufe Stratenus had faid to Tulpius, that he had feen fome-
thing very fimilar to it, as Tulpius himfelf readily confefles ; nor becaufe
Stalpart (g) aflirms that fomething of this kind was faid by Marcellus Do-
natus.
For Marcellus (b), although he fhows, in oppofition to Fernelius, that the
"waters, of hydropic patients, are brought by invifible pafifages into the cavity
of the belly ; and fays that, although this cavity is the more proper recepta-
cle of thefe waters, " it is neverthelefs prov'd, by difTeftion, that betwixt
" the peritonaeum, and the other parts which conftitute the lower belly, a
w portion of water is very often found." And that you may be in no doubt
what thefe other parts are, he immediately adds this which is very impro-
perly omitted by Stalpart : " fo that fome of the followers of the Arabians
" contend, that the general fituation of the water, in an afcites, is betwixt
" the fiphac and the mirach" (that is betwixt the peritonaeum, and the
parts that lie in con tact with it externally) " and we even fee, that in
* thofe who are troubled with this diforder, the water reaches to the hips,
" the legs, fj? c.cL" From this inftance then, you fee what portion of
water he fuppofes to have been found even in thofe parts ; that is to fay, the
water which naturally reaches thither, when an anafarca is join'd with an
afcites.
For in regard to that opinion of fome, who differ, very widely, from their
teachers, Haly (i), and Avicenna (k) \ neither is this obfervation proper to
prove it, nor is any other produe'd by Donatus: although Stalpart fays that
Donatus, after having afTerted a dropiy to be fometimes brought on by
drinking plentifully of cold water, if " it be carried into the humid perito-
(0 Dec. 3. a. 9. & 10. obf. 239. & cent. 3 & '(g) Part. 1. cent. z. obf. rar. 28. in fchol.
4 ob '. 117. & net. torn. 2. obf. 34. & cast. (/;) De med. hilt, mirab. 1. 4. c. 21. /
id) Via i:i ;;d. erud. Lipf. a. 1713. m. jti!. (?) Ttaor. med. 1. 9. c. 31. *
(e) L". 4. obf. med. c. 44. (k) C. 5. lupra ad n. 33. cit.
(f) Obf. anat. chir. II.
Vol. II. U u " nseum,"
330 Book III. Of Difeafes of the Belly.
" naeum," that Donatus, I fay, continues to fpeak, as follows: "Jacobus
" Camenicenus in his letter written to Andr. Matthiolus, in the fifth book
" of his epillles, tells us of a certain perfon, in whom water had been col-
" lected betwixt the coats of the peritonaeum, and of the inteftines." For
Donatus (I), after having copied from Aretaeus (m), who is exprefly quoted,
thofe words that relate to a fluid being then carried into the peritonaeum,
not to be collected there, but that from thence " the drops may be effus'd
" into the ilia," to produce an afcites; which drops were before converted into
" vapour, and carried off" by tranfpiration jM after having copied thefe words
then, likewife, and having added many other things, which by no means
relate to the peritonaeum, but to the imbecility of the vifcera, in perfons
who labour under an afcites, and to the obftruction of the veins of the
liver ; in order to prove this he at length makes ufe of that obfervation, of
Camenicenus, of {tones obftructing thofe veins, in a dropfical man," in
" whom water had been collected, between the peritonaeum, and inteftines."
For thus Donatus'himfelf, with juftice, writes, as Matthiolus does alfo, when,
in his anfwer to Camenicenus, he interprets thefe words of his, " when we
*' had gone through the mufcles of the abdomen, we found that kind of
41 water, which is call'd citron-colour'd, betwixt the peritonaeum, and in-
" teftir.es : which however I fee is doubted of by fome " that is by the fol-
lowers of the Arabians, who werejuft now fpoken of, and who thought that
the water, of patients in an afcites, was not betwixt the peritonaeum, and
the inteftines, but betwixt the peritonaeum, and the external parts. And
ihefe inquiries I have profecuted the more fully, becaufe I find that many
have afcrib'd the obfervation of the dropfy of the peritonaeum, to Cameni-
cenus, and Donatus ; without turning to thefe authors •, and in conjunction
with Stalpart, whom they have followed without mentioning his name ; among
whom is Nuck («), and he who has faid that he had compar'd his own ob-
fervation of this difeafe with that of Donatus, which is no obfervation at all.)
47. "Who then, do you fay, found this appearance before Nicolaus Tul-
pius ? Joannes Acholzius, a phyfician, and primary profefibr, at Vienna.
For this gentleman, in the year 158 1, having prefided at the direction of a
dropfical woman, in the prefence of the imperial phyficians, and furgeons,
found a great quantity of water, like a lixivium, not in the cavity of the
belly, but betwixt the peritonaeum, and the integuments of the belly ;
the mufcles, that is to fay, being fo far extenuated by the diftention of the
water beneath, that, as is often the cafe, " they feem'd to be almoft anni-
" hilated " or being even, in fome meafuje, chang'dinto a certaifl continued
body, made up of veficles, fill'd with water, mucus, and glandular mat-
ter, which compos'd the anterior paries of that very large iac : whereas the
internal was made up of a membrane, with which all the vifcera were cover'd,
in fuch a manner, that before this was cut into, there feem'd to be no vifcera
at all.
Read, I beg of you, the obfervation more fully defcrib'd in this fection
of the Sepulchretum (0), although confus'd with circumftances relating to.
other fubjects, and you will very plainly perceive,, that this was a dropfy of
(I J C. 21. cir. («) Ade. cur. c. 9.
(//;) C. 1. ad n. 45. fupra cit; foj Sect. 21. obi'. 21. J. 16,
tha
Letter XXXVIII. Article 48. 331
the peritonaeum, from water flowing out of thefe glandular tumours •, to the
diforder of which, and 'of this membrane, thofc rmferable pains, wherewith,
upon the great increaie or* the difeaie, the woman had been continually tor-
tur'd, arc certainly to be afcrib'd. Nor was this hiltory iirft publifli'd in the
Sepulchretum, but was extant from the year 1508 among the Con/ilia Medico,
publifh'd by Scholzius (/>) •, that is in a book, which went through more than
one edition, and which was in the hands or" almoft every one: particularly
in the lalt age,
O 1*1
But I have even obferv'd other oblervations in the Sepulchretum, which
were made before that of Tulpius ; and which may, or ought to be, refei'd
to the fame diieale : although nobody has ever yet taken notice of them, as
far as I know, at leait, when he was mentioning the others. That of our Spi-
gelius perhaps may, who, when he was in Moravia, remark'd " a fpurious
V droply," in a woman, " betwixt the abdomen properly fo call'd, and the
" muicles which are curv'd inwards as it were." (Should he have faid were
curv'd inwards ? Or was the cafe as it is in the obfervation of Acholzius ?)
From thence (which circumftance is omitted in the Sepulchretum) " ten
" pints of a black fluid flow'd." This was done in the year 1614, altho'
it was publifh'd by Rhodius (r) forty-three years after.
But, unlefs I am greatly deceiv'd, that which Hoechftetter (s) had ob-
ferv'd in a noble virgin, belongs entirely to the clafs I fpeak of: this obfer-
vation was made in the year 1628, although publifli'd many years after by his
grandfon ; and although the author fuppos'd the anterior part of the fac,
wherein a great quantity of thick and foetid humour was contain'd, to be the
peritonaeum, and the other part, wherein he found many glandular tumours,
among which four of the largeft were purulent, to be the omentum. For as
he fays that this internal part of the fac was " a membranous expanded
" body, wherewith all the vifcera and the interlines were cover'd," I believe
that it was the peritonaeum, notwithstanding it might poflibly have the
omentum agglutinated to it. But this you will better judge of yourfelf, for
you have both an obfervation, and a fcholium, in the Sepulchretum (t), in
which fome parts of this hiftory are contain'd.
48. And I would moreover have you read, very attentively, in the fame
book, two obfervations of Paawius (#), and one of Dodonasus (x) : and when
you read them I would have you obferve, whether any fufpicion begins to
arife in your mind, that any one thereof relates, in fome meafure, to the
diforder whereof I treat at prefent. For Paawius, in two hydropic women,
one differed in the year 1601, and the other in the year following, found
" not the leaft traces" of the fpleen, kidneys, and liver itfelf ; except that, in
one of them " the venous ducts only," of this laft-mention'd vifcus, " re-
" main'd, and they but very few in number."
How much lefs furprizing is it, if we fufpect that the peritonaeum was
diftended by a great quantity of water j and that, inwardly, in thefe places
(/>) Conf. 339. (t) Obf. cit. 12. §. 2.
(q) Sea. cit. obf. 12. §. 6. (u) Sett. cit. obf. 70, & 71,
(r) Cent. 3. obf. med. 6. (x) Ibid. obf. 20. §. 10.
(t) Obf. ir.ed. dec. lo.caf. 7. cum fchol,
U u 2 where
332 Book III. Of Difeafes of the Bell/.
where it happen'd to be moll attenuated, and lefs connected with fome of
the vifcera, it had burft ; and that where it was not thus attenuated it had
rcmain'd ; and that therefore ibme of the vifcera appear'd, in fome meafure, but
others were entirely hid •, and that thefe few veins belong'd to the perittHUeam
itfelffv): and that Paav/ius, in a very ha fly " opening of the belly," as he
himfelf fays it was, the bodies being in a very bad ftate, had not inquir'd ac-
curately into the cafe. And Dodonseus, in regard to a woman who had
been troubled for two years, with a very confiderable tumour in her belly,
which when open'd did not discharge water, but black inteflinal fordes, like
thofe which have lain in dunghils ; and thefe in the quantity of more than
fixty pounds •, readily confclTcs, that, in fuch a confufion of filthinefs, it was
not poffible to find out from what injur'd inteftine they had proceeded ; yet
that all the vifcera, except the omentum, which had been diflblv'd into putrid
fragments, were entirely found : but that the peritonaeum was fiiTur'd, in
fome places, from the fuperior to the inferior parts.
Here, I confefs, it is not at all to be wonder'd at, that the faeces had
flpw'd out of the inteftine, which was at length injur'd, and had polluted
the waters of a dropfical woman, which had been long-colle£ted. But it is
very furprizing, that lb large a tumour of the belly had afflicted the patient
for fo long a time, " with a healthy-colour'd countenance, without any
*' marks of difeafe appearing in the urine," and without any fwelling of the
feet. Thefe are marks, as we fhall fee below (z), of the dropfy of the peri-
tonaeum, wherewith this alfo agrees much more eafily, that the vifcera fhould
preferve their foundnefs for fo long a time. Moreover, that the peritonaeum,
being driven inwards, may adhere to fome inteftine, and communicate its
difeafe in fuch a manner, as to furTer the faeces to pafs over into the fluid
with which the peritonaeum is diftended, the obfervation of the celebrated
Chomel {a) ; which was taken from a woman alfo, whole belly, like the
other woman's in queftion, had begun to fwell after child-birth ; demon-
ftrates.
I fhould fuppofe, therefore, that you may eafily fufpect the peritonaeum
to have been, at length, burft afunder, as they faw it •, and an afcites to have
been fuddenly Wought on, from a long dropfy of this membrane (b) ; and
that the injury of the inteftine being increas'd at the time of this rupture,
the faeces had, during the latter days of the difeafe, flow'd in great quantity
into the cavity of the belly. And this obfervation of Dodonanis was pub-
lifh'd by him, together with others, in the fame year in which Acholzius
made his-, that is in 1581 : for it is very evidently a typographical error,
where, in Lindenius Renovatus, his obfervations are faid to have been publifh'd
in the year 151 8, as it is acknowledg'd that the author was born in the year
1517: which is a circumftance I fhould have taken no notice of here, if I
had not obferv'd that the fame error had alfo pafs'd into the Bibliothcca Scrip-
torv.m Medicorum.
An obfervation was alfo extant in Riolanus (<:), and not only in the laft
editions of his Anthropographia, " of water being extravafated betwixt the pe-
(y) Vid. infra, n. 56. in fin.
(zj N. 58.
(«) Mem. de l'acad. r. des fc. a. 1728,
fbj Vid. infra n. 52.
((J Vid, fupra a. 33. in fin.
monaeum.
Letter XXXVIII. Article 49.
v>J>
Itonacum, and the mufcles of the abdomen." Bat left you fhoukl fay that
k ought to be explain'd, in the fame manner as I have explain'd thofe words
or Donatus (J,\ 1 chofe rather to paft over it in this place.
49. Finally, in the year 1O51, the dilcafe we are ipeaking of, was lecn by
TulpiuSj and loon after communicated to the public, under the new name
or' Hydrops Peritonei {e) j in which publication it is exprefly affirm'd, " that
" all the congeries or waters had lain betwixt the two coats of the peri-
*' tonaeum, which had put on the thicknels of the ring-finger." The fame
hillory, kit you fhoukl, like a certain perlbn, believe it to be another, was
publilhM afterwards by him who diliectcd the body, Job Meekren (f) ; but
he publilh'd it more at large,' and told us that Walaeus was the only one,
out of fo great a number or phylicians, who hail coniictur'd the true fitua-
tion of this dropfy, while the patient was yet living. Neverthelefe, Tulpius
has fomething which is not to be found in that more full description: for
which reafon his defcription might alio have been transfef'd into the Sepul-
chretum, and that diftincYly from the other-, rather than that one fhoukl
have been made of them both, as you will fee is done by Stalpart (g), in
fuch a manner, that you are often ignorant what Tulpius, and what Mce-
krenius, has laid.
Bogdanus (b) alio, in a woman dififected by him, obfervM the peritonaeum
to be " of the thicknels of a man's thumb, rugous and rigid;" which circun,-
ftance, together with the remarks that are immediately added of the vifcera,
are very improperly omitted in the Sepulchretum (i). But he has afferted
that there was a fluid like lees of oil, not contain'd betwixt the coats of the
peritonaeum, but " contain'd betwixt the coat of the mufcles of the abdo-
M men, and the peritonaeum." That is to fay, what Tulpiusr and moft
others after him, took for the exterior lamina of the peritonaeum, he took for
the coat of the mufcles, with Bercngarius (k)y who taught formerly thus :
" It is true that, as far as appears to the fenfes, there is one very thin pel-
" kele, betwixt the true fiphac" (that is the peritonaeum) " and the broad
'*' mufcles of the belly •, particularly in the flefhy part of the mufcles : which
" pellicle is the panniculus that involves the mufcles, and other parts round
" about."
And I fee that this pellicle is now fuppos'd, by many, to conftitute, in
part, the cellular contexture of the peritonaeum ; which cells being ruptur'd
by the diftending water, a cavity is made " betwixt the peritonaeum, and
*' the tendons of the tranfverfe mufcles," or, as others more properly fay,
" and the tranverfe mufcles." But whether the peritonaeum has no exterior
lamina, befides this contexture ; or whether this contexture, itfelf, may not?
be cail'd a lamina, it is not a proper occafion now to enquire. It is fufHcient
to have fhown, that, before thefe latter times, there were not wanting fuch:
as plac'd the feat of this dropfy betwixt the peritonaeum, and the mufcles.
It is true, in what year Bogdanus wrote thefe things I do not know : but they
were, however, publifh'd by Bartholin (/), in the year 1665. Yet even
(«') Supra n. 46.
(e) Ob'f. fupra ad n. 46. cit.
{/) Obf". med. chir. c. 52.
(g) In fchol. fupra ad n. 46. cit.
(b) Obf. ibid. cit.
(/') Seel, hac 21. obf. 12. §. 4.
(k) Comment. 5. in Mundin. anat.
(1) In 2. edit, cultri anat. Lyferi.
twelve
334 B0°k III. Of Difeafes of the Belly.
twelve years before, it was not doubted by Olaus Rudbeck (w), but a drop-
fical tumour might be generated " betwixt the mufcles of the abdomen,
" and the peritonaeum." And in the year 1667 Gerard Blafius (n) found
water in the body of a virgin, " betwixt the mufcles of the abdomen, and
" the peritonaeum."
Yet this author thought that the fame thing might alfo happen, betwixt
the two lamina; of the peritonaeum. And this would be laid to have hap-
pen'd in moll of the obfervations, if they who fay that the cellular contexture
is broken afunder, had not in their power to anfwer, that the external part
of this texture, which adheres to the mufcles, is frequently, at that time, be-
come fo thick, and fo denfe, as to be taken for another lamina of the peri-
tonaeum, and even fometimes for the whole peritonaeum : which feems to
have happen'd to Hoechftetter (0), and others, among whom is Paulus Mothius,
•whofe obfervation on a matron is fo propos'd by Bartholin (p), as if a great
quantity of water had been collected betwixt the peritonaeum, and a pretty
denfe membrane covering all the vifcera, and filled with copious and large
veins •, in which membrane, a large abfcefs had been form'd about the
region of the liver : whereas three leflfer abfcefles occupied the lower part of
the membrane, near to the groins.
This obfervation was publifh'd in the year 1657. And I have pointed out
the vear in which every one of the obfervations, that I have mention'd, was
made public : in order to convince you, that the greater part of them were
in the hands of all perfons, before trie year 1688 : in which year Drelincurt
was created public profeffor, in that place, where one of his difciples, when
he wrote at large, that hiftory of the dropfy of the peritonaeum, received from
Drelincurt, which is added, in the additamenta, to this fecYion of the Sepul-
chretum (q), has faid what is quite unworthy of his very learned preceptor,
" that not the lead fhadow of a fimilar event is extant, either among the an-
" cients, or among the moderns, the celebrated Tulpius only excepted."
50. But now it will be fufficient to point out the obfervations of this
dropfy, which were publifh'd from that year 1688, quite down to the year
1692, in which Nuck (r), thefuccefifor of Drelincurt, publifh'd his own-, which
had been before communicated to Stalpart, and publifh'd by him (s). And
there were, befides thofe of Hoechftetter, and Blafius, which I have fpoken
of above (/), the three which you will fee are, as mod of the others are,
transfer'd into the Sepulchretum («), from Scultetus, Helwigius, and Spo-
nius : to thefe you will add one of Kniielius (x), which you will not be furpriz'd
to find omitted in the Sepulchretum, when you obferve that the obfervation
of Nuck is wanting alfo ! and from the time that Nuck (j), by his fkill, and
indultry, illuftrated this difeafe, there came out, in the firft place, three ob-
fervations which are copied in the Sepulchretum, one of Gahrliepius (2), a
(/;;) Exerc. anat. exhib. dudt. hep. aquof. (/) N. 47. £49.
c. 9. («) Seft. haczi. obf. 12. §. 1. & in addit.
(«) P. 1. obf. med. 18. obf. 25 £48.
(0) Vid. fupra n. 47. (x) Apud Zeller. diff. de vaf. lymph, admin.
(/>) Cent. 4. hill:, anat. 25. c. 1. n. 13.
(g) Obf. 41. (y) C. fupra ad n. 46. cit.
(r) (2) In cit. addit. obf. 81.
\i) Cit. fupra ad n. 46.
fecond
Letter XXXVIIT. Article 50. > 335
fecond of Drelincurt, which I mention'*.! jult now (a), and a third of Simon
Zylius, which isjoin'd with the laft.
Buc the other obkrvations could have no place in the Scpukhrctum, in
conllquence of their being publilh'd after the fccond edition thereof-, that is to
fay, thofe which were given by feveral authors, one by each : as by Littrc
(£) in the firft place, who added an explanation of the dilcafe, its figns, prog-
nofis, and cure, with more accuracy than others to that time-, and after-
wards by Hieronymus Laubius (c), Lucas Schrockius (d), John Palfin (<?),
from the communication of Favelet, and by other celebrated men, as Jo.
Georg. Hoyerus (f), Jo. Hermann Furftenau (g\ Jo. Chriftoph. Pohlius (£),
and, finally, by Jo. Henr. Reipingerus (i). The obkrvations, therefore, of
thefe authors, and of all thofe who are mention'd above, were in my hands,
when I laid to you, and did not in the leaft doubt, but others might exift
befides, both of the antients and the moderns.
Among; the reft, neverthelefs, do not imagine that I here forget to re-
count the obfervation which Chomel (k) has given, greatly to the praife of
his fkilfulnefs and dexterity, where he alfo adds a fecond •, but both of them
taken from the living body only. I, however, in this recital, according to
the order of time, have purpofely omitted to number them amongft the
others, as I alfo have, two in particular, which were produe'd by N-uck (/) ;
one from Bartholin, as if it had been his, and not Brechtfeld's •, and another
from a phyfician who was his friend •, not becaufe I judge them to be without
their ufefulnefs to thofe who treat of this difeafe (for I myielf have made ufe
of one of them, as far as was proper, above, and fhall perhaps make ufe of
one below) but becaufe neither of them is confirm'd by anatomical infpec-
tion.
But thefe four laft-mention'd obfervations, and others of the fame kind,
which will be produe'd below, were taken from women, as the others were
alio; not only thofe that are pointed out by Rudolphus Jacobus Camerarius
(;»), who had taken notice of the very fame thing, but all the others, more-
over, that have hitherto been mention'd by nie, or will be mention'd here-
after : infomuch that as yet, if you except jnft one example (»J, a dropfy
of the peritonaeum has not been obferv'd, except in the female iex. Of
which circumftance, and of others, that I have peculiarly obferv'd, in com-
paring fo great a number of hiftories with each other, I fhall lay fomething
prefently, after I have firft, of all the Italians, as far as I know, added the two
hiftories which 1 promis'd you ; left you fhould fuppofe, that, as out of all
thefe women there was no Italian, our women are not fubjefr, to this diforder;
which is pretty rare indeed, lb that neither Valfalva, nor I, have hitherto lit on
it in difiection ; yet not fo rare, but that our Mediavia has feen it twice in
this hofpital, and communicated both of the obfervations to me, in the fol-
lowing manner.
c
(a) N. 49. in fin. (g) Earund. t. 8. in obf. 7S.
(b) Mem. de 1'acad. r. des fc. a. 1707. \b) Ibid. obf. III.
(c) Eph. n. c. cent. 4. obf. 162. (/) Aft. Helvet vol. 1.
{d) Earund. cent. 5. obf. 23. (i) Mem. de l'acad. r. des fc. a. 17:8.
(e) Anat. du corps hum. p. i.tr. 2. ch. 4. (/) C. cit.
(f) Act. n. c. tom. 4. obf. 32. & torn. 5. in (m) Bigaobf. med. c. i,
«bl. 6.8. [n\ Vid. n. 59.
51. A
236 Book III. Of Difcafes of the Belly.
51. A woman not yet advanc'd in age, and of a good complexion, had a
tumour of the whole belly. She laid that before this happen'd to her, a kind
of tumour might have been felt at the left fide of the navel, unequal in its
furface, and of fuch a magnitude, that it equall'd almoft the breadth of her
hand, when laid upon it. When fhe was fuppos'd by fome to have an
aicites, for this very reafon, which was doubted of by others on account of
the natural colour of her face, lhe died.
The tranfverfe mufcles of the abdomen being cut into, a great quantity of
very (linking water burftforth,which was feparated, from the cavity of the belly,
by the peritonaeum. This being exhaufted, the tumour of which the woman
had fpoken came into view •, having been generated in the peritonaeum, and
confifting of two or three large bladders, as it were : the parietes of which
were fo thick, that upon drawing out the water they contain'd, they did not
at all fubfide, or collapfe.
52. Another woman, about twelve years after the former, that is in the
year 1725, came into the hofpital in conlequence of her being troubled with
a difcafe no lefs inveterate, but even more fo. For flie faid that when fhe
was forty years old, and fhe was at this time in her fiftieth year, fhe was
troubled with certain tumours in the upper part of her belly, which lay at a
diilance from each other, and were not free from pain, if they were touch'd:
and that thefe tumours, notwithftanding a great number of different remedies
were applied, both externally, and internally, had increas'd; and fhe had con-
tinually grown worfe. Even then, although the whole abdomen was dif-
tended, it was eafy to diftinguifh the tumour with the eye, as well as with
the hand i for the tumours that had been before disjoin'd, had coalefc'd into
one unequal tumour, which, when touch'd, gave pain, and was plac'd betwixt
the cartilago enfiformis, and the navel : yet fo as to touch neither of them.
The colour of the fkin, in that part, was the fame as in others : and if you
attempted to lay hold of it with your finger, and raile it up, you could not
do it ; lb that, for this reafon, feme fuppos'd the tumour to be in the mufcles
of the abdomen themlelves. But others ; confidering the colour of the
countenance, which inclin'd to yellow, and the very great difficulty of refpi-
ration of which the woman, in particular, complain' d ; fuppos'd it to relate to
fome diforder of the vifcera. Yet there v/as no mark of the ftomach or
inteftines being injur'd. In the mean while, black vomitings being added
to the flight fever with which fhe was troubled, death put an end ,to her mi-
Jcrable life.
The integuments, and mufcles of the belly, which was obferv'd to be lefs
tumid than it had been in the living body, being accurately feparated ; and
with thefc even the tendon of the tranfverfe mufcles •, a thin membrane ap-
pear'd to lie under the tendon, and flefh, of thefc mufcles, between winch,
and another, that in thicknefs was equal to one line of the inch of Bologna,
was comprehended a cavity containing a tumour, not only form'd on the ex-
ternal membrane, but alio extending itfelf downwards, and to both (ides ; fo
as to contain a great deal of water, in colour like to that wherein frefh meat
has been walh'd, of a very filthy fmell, and of a purulent thicknefs, in the
part where it had fubfided: the quantity of this water might be computed
at
Letter XXXVIII. Article 53. 337
at about thirty pints, not lb much from that which was found in this cavity,
as from what had been extravafated into the cavity of the belly; the lower
membrane, of this morbid cavity, being eroded over agamft the ftomach : and
this I fuppofe to have happen'd about the latter' end of the difeale, from
whence the abdomen appear'd to be lefs tumid.
However, this peculiar tumour of the epigaftrium was made up of a firm,
and hard fubflance, of a white colour inclining to yellow, wherein a few cells
were, in tome places, oblerv'd. And the membranes, furrounding the cavi-
ty, had already begun to be eroded in more places than one, and to grow
black on the furfaces, by which they were turn'd towards each other ; and
on the fame furfaces they were rough, and unequal. But on the furface, by
which the lower membrane was turn'd towards the belly, it was fmooth,
unlets where any part of the omentum, and the large inteftine, was connected
to it; which connection, however, was not very 'firm. There was, alio, a
kind of fmall rope, as it were, connected, on one hand, with the fame
membrane, and on the other, with the lower vertebra of the loins •, which,
when diftected, pour'd out blood. Moreover, the inteftines were in fome
meafure inflam'd : but the omentum, and the other parts of the belly, were
found-, if you except the liver being of a pallid colour, and grating, as it
were, under the knife, as if fandy particles had been mix'd with its fub-
ftance.
53. Now fince we have a fufficient number of obfervations on the dropfv
of the peritonxum (to let afide thole which leave fome room for doubt: ) to
compare one with another; it is fomewhat lefs difficult to add a few things in
relation to the caufes, nature, fymptoms and cure thereof.
In relation to the caufes therefore ; where Nuck (o) has faid that the
branches of the lymphxduds creep betwixt the mufcles of the abdomen, and
the peritonaeum, as Rudbeck (p) had alio faid ; and even has clearly demon -
ftrated, that they run betwixt the two laminae of the peritonaeum ; and purfued
his invention, by fuppofing that thefe branches, being obftructed, from any
caufe whatever, are form'd into hydatids, from which, when ruptur'd, a
dropfy of the peritonaeum arifes ; he has immediately, alfo, added this, that
gluttons, and women who bear children, are particularly liable to* this
danger of oMlruction.
For that, in both of thefe claffes, the mufcles of the abdomen, being im-
moderately diftended, give a refiftance, on one hand ; and, on the other,
the ftomach, and inteftines, or the uterus, by its fullnefs, force outwards ;
lb that the lymphatic veffels being intercepted betwixt this preffure, and that
refiftance, it is eafy for us to conceive, that fome of the neareft branches, of
thefe canals, may be fometimes lb diftended, by the retarded lymph, as to
be burft afunder. And indeed in many of the obfervations juft now quoted,
we read that this dropfy had happen'd to thofe women, who had been mo-
thers of many children ; and even to fome a little after abortion, or a diffi-
cult birth, as in the obfervation of Knifelius (q) ; and indeed immediately,
or almoft immediately, after birth, as in the obfervations of Dodonaeus (r),
(r>) C. 9. fupra ad n. 46. cit. (y) Cit. fupra ad n. 50.
(p) C. 9. fupra ad n. 49. cit. (;•) Cit. ad n. 48.
Vol. H. X x and
338 Book III. Of Difeafes of the Belly.
and Chomel(*)i if you think that they really and ftrictly belong to this
clafs.
Yet, although I readily admit uterogeftation among the caufes of this
d'.-opfy, I cannot, however, understand why this diforder has been but once
obferv'd in any other bodies, but thole of women. Nor were all thefe pa-
tients child-bearing women : and me, of whom Furitcnavius (s) gives the
hiftory, was certainly barren •, as many of them were virgins, which is de-
monstrated by the hiftories of Hoechftetter (0, Siratenus («)> Drelincurt
(x)y Schrockius (y), Palfin (z), Hoyer, (a), and even Tulpius (b) : for
the woman defcrib'd by him had always, even before fhe married, had,
*•* from her early years, a very tumid itate of the* belly," as is related by
Meekrenius (c). Shall we therefore return back to that other caufe, and
fuppofe all thefe virgins to have been great gluttons ? But this is not even
a vice that happens among women, except very rarely •, and as to the males
among whom it frequently happens, we know of no more than one hitherto,
who has been found to be affected with this diforder.
54. You will conjecture, perhaps, that another caufe ought to be added,
which is peculiar to women •, efpecially that which Camerarius hints at (rt), when
he fays that he had read " in almoft all" the hiftories of this difeafe, that the
bag, in which the water was contain'd, had been connected with the fide of
the uterus in particular, or its appendages ; therefore that he, in the woman de-
fcrib'd by him, had dcriv'd from thence, the origin of the bag, which was
not fo much connected in any other part, as in the feat of one of the ovaria,
and of the tube, which two parts were likewife wanting. Thus his fon, alfo,
after that (<?), defcrib'd the beginning of another bag connected with the
rig-ht ligaments of the uterus, and the right ovarium ; or rather with their
fituation, or remains, as they themfelves were obliterated.
But I fee that Meekrenius (f) had, before, obferv'd the fame ovary to be
deficient -, and even its tube producing itfelf into the peritonaeum, -of which
the bag'confifted, and degenerating into it *, as he has reprefented by a figure :
and that Gahrliepius (g) had made ufe of this very fame word, when he fig-
nified that the fame parts, and the ligament which lies betwixt the ovary, and
the tube, were carried away into the peritonaeum, which was continued from
thence, and in which many bags were comprehended. I omiPothers, and
among thefe Laubius (b), by whom the iac of the peritonaeum, which he
defcribes,. is faid to have a very firm connexion about the fundus uteri,
though eafily feparable in other parts, by the fingers alone : and even Littre
(1), the interior membrane of whofe fac was connected with no other vifcus,
but with the extremity of the left Falloppian tube; which being firmly fix'd
to it, had been fo ftretch'd as to become twice as long as it naturally is.
But I cannot help taking notice of Sponius (£), as the obfervation he has
communicated fpeaks of a lac, that could not only be feparated from all the
(*) Cit. ad n. 48. (£) (r) Ad n. 46.
(/) Ad n. 50. (d) Ad n. 50.
(t) Ad n. 47. (e) Ait. n. c. torn. 1. obf. 160.
(u) Ad n. 46. (f) Cit. ad n. 46.
(x) Ad n. 49. (g) (/>) AJ n. 5c.
(,) (z) (a) Ad D. 50; (f) (k) Ibid.
c yifcera.
Letter XXXVIII. Article 55. 339
vifccra without laceration, except from the fame tube from which it wa-j
continued, but even communicated with the cavity of the uterus, fo that the
patient had a continual dripping, from her genital parts, of a ferum of the
lame kind v/ith that which the lac itfelf eontain'd, in the quantity of a hun-
dred and forty pints; the communication being alio confirm'd by the probe,
it feem'd probable that the tube had produe'd its parietes into the parietes
of the fac. And Camerarius the father, who had mention'd molt of thefe
alfo, hinted at a method, after fome one of our countrymen, by which, if
the return of the blood, from the ovary, is obftrudlcd in the fpermatic vein,
the ferum may, by its ieceflion from hence, in confequence of its creeping
betwixt the two lamina of the peritonaeum, infinuate itlelf between tlielc
two laminae, according to the experiment of Lower (/) ; and thus, by disjoin-
ing them, begin to form the fac.
But notwithftanding I acknowledge thefe obfervations to be true-, and even
confefs the caufe, if explain'd a little more fully, and accurately, than I have
done here, to be probable alfo-, and lee that it may be, likewife, farrher
transfer'd to other veins, fometimes, that run in this fituation •, yet we either
conceive, or know, that the ovaria, the tubes, and the uterus, were quite
unaffected in this dropfy, according to the obfervations of Helwigius (w),
Knifclius f»), Pohlius (o), and Mediavia (p) : and what relates ft ill more to the
lubjedt in queftion, it is not certain that they were difeas'd in any of the virgins
who have been fpoken of, if you except one: and even it fufficiently appears
that they were not affected in moft of thefe patients, as all the vifcera of the
belly are laid to have been found. Since thefe then were not child-bearing
women, nor had any thing in the uterus, or its appendages, which could
give an origin to this difeaie, that was peculiar to women ; it is evident that
it is neceflary to add fome other caufes, to thole two which I have mention'd,
that are either proper to the female lex, or are more common among that
fex than ours.
55. But while you are inquiring after others, I will reckon up a few ; as,
for inftance, the conflux of the blood, every month, into the inferior parts
of the belly; their fedentary life, which is not quite fo proper to promote its
return ; the more weak refiftance of the female body, againft caufes of difeafe,
whether external or internal ; and, in conjunction with this, that moft vile and
deteftable cuftom of confining the belly with ftays, efpecially when they are
hard and ft iff ; vile and deteftable cuftom, I lay, becaufe no difapprobation
can be more fevere than the extreme mifchief of them requires.
For to add, to the other inftances of detriment caus'd by ftays, that are
taken notice of by the celebrated Window {q ), this over and above ; while
the lower part thereof continually, and clofely, compreffes whatever part of
the abdomen lies betwixt the terminations of the thorax, and the upper edges
of the offa ilia, it is eafy to conceive, what an obftruction is thrown in the
way both of the lymph's, and the blood's motion, in thofe veffels alfo, which
are betwixt the mufcles, and the peritonaeum ; efpecially where the fto-
mach and inteftines ; being diitended with flatus, at leaft, if not with meat
(/) Traft. de corde c. 2. {p) Supra n. 52. in fin.
(m) [») (0) Cit. ad n. 50. (q) Mem. de l'acad. r. des fc. a. 1 741 .
X x 2 and
34-o Book III. Of Difeafes of the Belly.
and drink •, force out the abdomen from within, and prefs it againft thefe
ftays.
But if the lymph or the ferum be not, for this reafon, extravafated into
that interftice, in the manner I have mention'd (r) ; particularly in thofe,
whole fluid or firm parts are difpos'd to it more than they are in other pcr-
lons •, yet it may happen to the fame perfons, that fome part of the retarded
lymph, or blood, may form the beginnings of tumours in thofe parts,
which, being increas'd after a long time, may divide the peritonaeum from the
mufcles, in iuch a manner, that the branches of the lymphatic veffels, being
pulPd away, or ruptur'd, may bring on that dropfy, which the conftriction,
and prefiure, had not, of themfelves, brought on : and the fame branches
being, at length, brought to fuppurarion, may increaie the dropfy by pu-
rulent ichors. 1 percciv'd tumours of this kind, by examining the epiga=-
ftrium with my hand, in a matron of rank, who had been compell'd to
wear ftifF (lays, from the time of her being quite a little girl ; and thofe fo
much the differ, and more tightly lae'd, in proportion as her relations were
more afraid of her being diftorted : thefe tumours were as yet fmall and at a
diftance from each other •, and I immediately perfuaded her to wear ftays that
were lei's ftifF, and in a different manner.
You yourfelf might fee, in what region of the abdomen, the fame tumours,
now grown large, had been form'd, in the two women whofe hiftories I
laft gave you (s). Nor, indeed, were the tumours, or abfeeffes, in any other
region, which Laubius (I) found to the number of fix ; nor the larger of thofe
four which Mothius, as is faid above (;/), found growing to the fac. But
you will not be at a lois to conceive, how thofe which occupied the inferior
parts of the lac, in the fame obfervation of Mothius, or in the obfervations
ofNuck(*), and Littre (x), might poflibly derive their origin from thefe
ftays •, when you call to mind the lower parts of them, and the ftiff-pointed
parr, which is added to the middle of them before, in a longitudinal direc-
tion : for by thefe the region of the abdomen is comprefs'd, and all the vef-
fels that lie there, whether lymphatic, or ianguiferous •, and particularly when
the woman is in a fitting polture.
56. As among the caufes of this dropfy, we have admitted tumours
form'd in the peritonaeum, which not merely by pulling afunder the parts,
as I faid in purfuance of the opinion of others only, or by laying an obftacle to
the motion of the lymph, and blood, may bring on this difeafe •, but alfo may,
when they are fuppurated, increafe it by the addition of deprav'd ichors •,
we may eafily underftand this to be a corollary taken from thence, that, in
order to explain the putrefaction, ftench, power of eroding, and creating
pains, which are often found to exift in the collected water, it is not always
neceflary to accufe the long ftagnation of that water •, on account of which
the faline, and fulphureous, particles m3y be feparated from the others, and
cccafion thefe effects. But if ftagnation could always do this, it would cer-
tainly have done it in a great degree, after four years, after ten, after many
more, as in the obfervations of Camerarius the father ()), of Schrockius (z%,
('-) N. 54. (.0 N. 49.
{s) N. 51. & 52. O (at) Cit. n. 5c.
(/) Cit. n. ^o. (_v) [z) Ibid.
and
Letter XXXV1IL Article 57.
and of Meckrcnius (<?): yet in thefe obfervations were none, or fcarccly any,
of thefe fymptoms obfcrv'd. And there had even been neither tumour,
ablcefs.
However, tumours do more frequently appear, either form'd of a glan-
dular matter, or difpos'd in the manner of cells, bladders, or globules, a*;
you will fee remark'd by Acholzius (/>), I Ioechftettcr (V), Bogdanus, (d),
Knifelius (7J, Mothius (f), Littre (g\ Refpinger (gg), and Mediavia (b)\
and thefe either in great number, as by the firft four, or even, in fome places,
fo gathered together into a heap, that, according to the obfervation of
Acholzius, " they were equal in thicknefs to the breadth of a man's hand."
And Malphigi (/'), where he, in Jbme meafure, led the way to the explica-
tion of Littre •, averted it to be owing to the glandular nature of the mem-
brane of the peritonaeum, that, in this difeafe, " notwithstanding the dilata-
M tion, it becomes more thick than is natural :" for he fays that this is " the
" property of glandular follicles, when affected by difeafe ;'' and, indeed, it'
you read Schrdckius (k), Laubius (I), Sponius (wz), Drelincurt, (n), Nuck
(c), and Littre (/>), you will fee how much it has been found to be thicken'd ;
and ftill more if you read Knifelius (q), who, in one place, faw it, " of
" the thicknefs of half an inch ;" but itill much more, if you call to mind
thole things that I related to you from Tulpius (r), and Bogdanus (j)..
Therefore, if you mould choole rather to account for this increafc in
thicknefs, in the way of Malpighi, you will eafily conceive how much the
fecretion of the included humour is increas'd, in confequence of an increafe in
the fecreting organs ; efpecially when you attend to the great dilatation of the
veffels, which belong thereto. For Bogdanus faw, very plainly, the internal
epigaftric veins, and their " extremities, to have tubercles like a filbert, as
'* if they had been papillae, and even notch'd •,." and Knifelius (t) " the veins
" very much extended, and terminating in globules." And the fame dila-
tation, befide the hiftory of Mothius given above f#), is prov'd from what
Palfin (x) afferts of the mammary, and hypogaftric veins (though perhaps
he meant to fay epigaftric) being enlarg'd to the thicknefs of the little finger.
And how much the blood-veffels, betwixt the peritonaeum, and the abdo-
minal mufcles, may dilate themfelves, nothing more clearly fhows, than the
circumftance related by Anthony de Pozzis (y)9 of very black blood being
found betwixt them, to the quantity of eighty pounds, in a plethoric and,
at the fame time, dropfical virgin.
5j. Thefe fountains, or origins of the fluid, being thus added, and ex-
plain'd, there will be lefs reafon to wonder at the van: quantity of water,
which has been found, by many perfons, in a dropfy of the peritonaeum : the
greateft quantity of which I do not mention here, as I am afraid of being led
into fome error, by the meafur.es being different among different nations..
(?) Refo. ad epift. de recent, medic, ft.
(*) (lf{m) {n) (o) 0>) (?) Cit. adn. ?'•
(r; (s) Ad n. 49.
(/J Ad n. 50.
(u) Ad n. 49.
(at) Ad. n. 50.
(y) Egli. u. c. dec. 1. a. 4. obf. 41.
But
(«) N.
49.
V) (c)
N. 47..
(<0 N.
49-
{ej N.
sO.
(f) N.
49.
(g) 0
g) N. ,-0.
(*) N.
51.5a.
342 Book III. Of the Difeafes of the Belly.
But the difpofitions of the fecerning organs, in confequep.ee of their being
preternaturally arfedted, join'd with the various conftitution of the blood,
will diminifh our admiration, when we read that a different kind of humour#
or fluid, was found in different cafes, inftead of a limpid, or fluid ferum ; fo
that even in fume, as by Gahrliepius fz), and Camerarius the fon (a), it was
found to be like jelly, or gluten : or if in fome it has been found lefs de-
prav'd, yet in others, humours of the moft vitiated kind have been
found, and ichor proper to produce ulcerations, or even to confume the very
parts themfelves •, if, however, in the woman fpoken of by Acholzius (b),
the mufcles of the abdomen were really almoft annihilated, and not rather
chang'd into any other form, or extenuated by their emaciated Mate, as in
the cafe given by Nuck (c); or even by too great diftention, as in the rela-
tion of Gahrliepius (d), and, as it in part feems to have been, in the obferva-
tion of Littre (e).
58. To thefe things that I have curforily hinted, in regard to the caufes,
and nature, of this difeafe, it will not be improper to add fomething in regard
to the figns. You will know it from the afcites by thefe marks : firft, be-
caufe it increafes, for the mod part, more flowly than that, and particularly
in the beginning, as almoft all the examples fhow ; among which I know not
why fome have here had an eye to the obfervation of Blafius (/), wherein not
a word is faid of the time : and I faid, for the moft part, that I may not
feem to you to be in an error, if you mould fuppofe that the hiftories of
Nuck (g) and Chomel (b) belong to this clafs ; the firft of whom faw the tu-
mour of the belly increas'd to a very great fize, " in the fpace of a month,"
and the latter even in a much fhorter time.
In the fecond place, the face, in the difeafe I am treating of, continues to
have its natural colour ; as the obfervations of Drelincurt (i), and Littre (k)\
teach us, and one of Chomel's (I) feems to hint: and, indeed, Nuck (m)
firft exprefly advane'd this, as one of the figns •, although I fee that a virgin
had been formerly defcrib'd by Dodonsus (n), who, through the whole time
that fhe was troubled with a tumour of the abdomen, " had a continually
*' elegant and lively colour of her face, juft as in health ;" yet the tumour
was from urine, which the bladder, being piere'd through with ulcers, had
pour'd out into the cavity of the belly.
In the third place, the ftrength, and action of the body, agree with the
complexion, as is teftified by the fame Nuck, and prov'd by examples ; not
only thofe three which I juft now fpoke of, but alio by many others, and,
in particular, by that of Meekrenius (<?), who remarkrd an almoft incredible
agility with that weight, and even utero-geftation, and regular child-birth ;
which are related by Laubius (p)y fo that the infant liv'd : and the woman
fpoken of by Scultetus (q), bore a child three times, and " always with a pro-
" per evacuation."
{z) Cit. ad. n. 50. (%) [})) Ad n.. 50.
(«) Ad n. 54. (i) (i) (I) (*) Ibid.
(b) Ad n. 47. (>') Medicinal, obf. c. 34.
(0 (<*) W Ad n, 50. (0) Cit. ad n. 49.
(f) Ad. a, 49. (/>) (?) Cic. ad a. 50.
The
Letter XXXVIII. Article 58. 343
The obfervation of the menftrual evacuations being duly preferv'd was ftill
more frequent, as in thole three authors whom I quoted in the firlt place, in
regard to colour: to whom you may add Camerarius the father (r), and
Schrockius (s) ; but others have either fallen into this dropfy, after that pur-
gation has ccas'd from age, or, which is more frequent, after its being fup-
prefs'd, or not properly regulated : fo that married women have thought
themfelves pregnant, and virgins have had their reputation fufpected. As to
thirft, and the quantity of urine dilcharg'd, although I read of the wo-
man defcrib'd by Nuck (/), " that notwithstanding fhe was troubled with a
" thirft, and drank a great quantity of liquids, for the molt part, (he made
" nevertheless but little water ;" yet in others, I either obierve nothing at
all to be laid about it, or it is laid, in general, that the patient had liv'd
pretty comfortably, or, at leaft, without any particular uneafinefs, that great
Joad of belly excepted •, or it is even exprefsly laid, " that the urine had con-
" tinu'd unchang'd at the time of its difcharge, in its confiftence, colour, and
" fediment," as by Drelincurt («) ; and in the fecond obfervation of Chomel,.
that the matron had no thirft, and dilcharg'd her urine naturally as ufual :
and I fee, befides, that in the woman fpoken of by Nuck, the urine was
" fomewhat pale," and not faturated, as it is in thole who have an alcites ;
but that a fmall quantity of this difcharge, and a thirft, have been remarl.'d
in the difeafe, after having made a considerable progrefs, and being compli-
cated with other diforders, particularly with calculi of the kidnies.
For when the difeafe has continu'd a long time •, and it may be carried on
to a very great length, even to the lpace of many years (which is a circum-
ftance, of itfelf, Sufficient to diftinguifh this diforder from the alettes) and not
only to the fpace of four years, as Littre (x), and others, to fix or feven as
Laubius (y), to eight as Bogdanus (z) and Knifelius (a)t to nine as Sculte-
tus {b), to ten as Nuck (c)y and others, have feen it; but it is even certain,,
as is fnown above (d), that it may be born for more years than thefe : when
the difeafe, therefore, has continu'd a long time, it is not to be expected that
the greater part of the good fymptoms Should remain. But it is fuffiVient
that there have been mod of thefe good figns, in order to diftinguifh the
one from the other : which is alio true of the other fymptoms that I am going
to add.
For, in the fourth place, there was no fwelling of the feet, except in the
cafe of Gahrliepius (e), in the beginning of the difeafe ; none, except near the
clofe of it, and not even then in all : no wafting of the other parts, and
of the body in general; no difficulty of breathing-, no flight fever; no pain.
Yet when the difeafe is far advane'd, all thefe fymptoms are, for the inoft
part, accuftom'd to come on ; and efpecially if with the water there are in-
ternal tumours, which come to fuppuration, and the lac becomes ulcerated :
although we have the defcription of an highly emaciated ftate of body coming
on, even without thefe fuppuratio-ris, from Drelincurt (f) ; and of a conti-
(rj (s) (t) («) Adn. jo. {J) N. ;6.
(x) (y) Ibid. \t\ Cit. ad n. 50..
(a) Ad n. 49. (f) Ad n. 49.
{a) (b) (c) Ad n. 50,.
niaL
344- B°°k HI- Of Difeafes of the Belly.
nual, and intolerable pain, particularly in the night-time, from Achol-
zms(g).
In the fifth place, medicines are of no advantage : and whether you ftrive
to increafe the dilcharges by the bladder, or interlines, the tumour of the
belly is not diminifh'd ; but the ftrength of the patient is rather diminifh'd,
especially if any violent, remedy be made ufe of; and her miferies are en-
creas'd : fo that I do not remember to have read an inilance of any one,
v/ho has been in the leaft reliev'd, for any fhort time, in this dropfy (which
is a circumftance that happens frequently in an afcites) not to fay that has ever
been perfectly cur'd.
59. But although thefe figns may be of ufe to diftinguifh thcfe dropfies
one from the other, yet I do not know of how much advantage they may
be in diftinguifhing this of which I am treating, from another peculiar kind
of dropfy. For I have obferv'd that the fame Nuck, when he propofes the
greater part of the figns which I have enumerated -, lb that if they are ftill
good, the water may be drawn off from the peritonaeum ; does not feem very
well to have remember'd what he had aflerted in the chapter preceding (h).
I, fays he, " have learn'd, by experience, that thofe women whofe face is of
" an agreeable rofy colour, who have a pretty good appetite for food, drink,
" go to (tool, and make water without any confiderable uneafinefs, whofe
" bodies are not much affected by purgatives, by diuretics, nor by diapho-
" retics •, I have learn'd, I fay, that thefe women generally labour under a
" dropfical diforder of the uterus, the Falloppian tubes, or the ovaries ; and
*' that the lymph which is included in a peculiar fac, can be carried off by no
" art:" by which he underftands furgery as well as medicine. And as to the
other figns which he has not touch'd upon, you eafily fee, by the light of
realbn itfelf, that thefe, alio, may be common to the dropfy of thcfe parts, and
of the peritonaeum.
Let us fee, therefore, what the remaining figns of the dropfy of the peri-
toneum are. For they are thofe which are taken from the inlpection of the
abdomen, and the examination thereof with the hand. And that certainly
would have been the molt eafy, and natural, which I remember to read pro-
posal by a certain very famous man ; I mean, that in this dropfy there is al-
ways the fmalleft prominence about the navel : becaufe in that part the
peritonaeum cannot be feparated from the tendons of the mufcles. But the
cafe teems to have been quite different, as it appear'd to Hoechftetter (i), to
Drelincurt (k), and to Nuck (I), the firft of whom faw the navel, in this dif-
eafe, " expanded, and altogether dilated •" the fecond " projecting ;" the
third " prominent," to fuch a degree, as confiderably to exceed the fize of a
" fill." And what will you fay to this, that a countrywoman defcrib'd by
the celebrated Brehmius (m), had not only her navel prominent to the fize of
agoofe'segg; but even that the tumour, being fpontaneoully ruptur'd, al-
ways pour'd out, on every other day, fuch a quantity of limpid and inodo-
(g) Ad n. 47. (k)
(%) 8. Adenogr. (I) Ad n. 50. ,
(/) Cit. ad. n. 47. (m) Aft. n. c. torn. 8. obf. 79.
TO US
Letter XXXVIII. Article 59. 345
rous ferum, that the large tumour of the belly being entirely got rid of, the
patient rccover'd.
But, as it only fecms " moft probable" to the author, that this was a dropfy
of the peritonaeum, it is proper that I produce a more certain example, and
one that is confirmed by anatomy, as I generally do, and that from the cele-
brated Anhornius («). A young man, who was the more readily fuppos'd to
be troubled with an afcites, becaufe he had, more than once before, labour'd
under an anaiarca, having his navel grown out to the bignefs of a fift, and in
conlequence thereof, fpontaneoufly ruptur'd, had a great quantity of ferum
difcharg'd from the fiflure, fo that health feem'd to be reftor'd ; but after
two months, the navel darted out again, with a freth-colledted fluid, which
was a fecond time difcharg'd : finally, a third time the tumour, which had
twice vanilh'd, diftended the abdomen ; but as he was now become tabid, the
fluid, which was again difcharg'd in the fame manner, was of no effect in
preventing the fatal period of the difeafe.
By diflection, no ferum was difcover'd in the cavity of the belly, but what-
ever of this fluid remain'd was found " betwixt the duplicative of the peri-
" toniEum •," where the fountains, or origins of it, that is to fay, " many lym-
" phatic tubuli, or little glandular knots, which, when prefs'd, wept a limpid
" water," were alfo found. And thefe things I have related the more at large
for this reafon, becaufe this is the only example of the dropfy of the perito-
naeum, which I have hitherto been able to meet with in the male fex. For as
to your being, perhaps, ready to fuppofe, on reading the cafe of a great
man (o), whofe belly fwell'd in the decline of a fever, which had been join'd
with a grievous colic, and decreas'd in its fize, by reafon of the navel, which,
had been a long-time prominent, being fpontaneoufly ruptur'd, and pouring
out " thirty pints and more of true and very foetid pus," and afterwards a
confiderable quantity alfo ; a fiftula of the navel remaining behind, with two
fcirrhous glands, as it were, at the fide thereof; as to your being ready to
fufpect then, that this cafe ought to be referr'd to the clafs of dropfies of the
peritonaeum, 1 would have you firft confider, how different from your fufpi*
cion, was the opinion of the phyfician who was far the moft fkilful, although
he propos'd the matter by way of problem ; and in the fecond place, that al-
though the morbid matter was tranflated into the fame fituation, wherein that
dropfy is generated, or, if you pleafe, collected there, yet that this was not
ferum by any means, but real and true pus.
And I have not prefum'd even to enumerate the Angular obfervation of
Gabbriellius (p) on a woman, among the examples of dropfies of the perito-
naeum, notwithstanding he found that the almoft incredible quantity of wa-
ter, had not been in the cavity of the belly, but " betwixt the peritonaeum
*' and the mufcles." For that water did not feem to me to have been fecreted
there, which could be carried off in the fpace of three days, by the ufe of
fome hydragogue medicines, in fo great a quantity, that the vaft tumour of the
belly quite fubfided, which I have faid above (q) does not happen in this
fpecies of dropfy. And indeed as this woman had her dropfy come on after
(a) Eph. n. c. cent. 9. obf. 100. n. 2. (p) Eph. B.C. dec. 3. a. 5 & 6. obf. 279.
(0) Conmierc. littcj. a. 1735. hebd. 37.11. 2. (7) N. 58. in fin.
Vol. II. Y y an
34-6 Book III. Of the Difeafes of the Belly.
an inflammation of the fpken, that vifcus was found to be the only one
which was difeas'd •, " fume ulcerous finufles" therein, by means of mem-
branes that lay between, " conftituting a kind of fmall canal •, whereby a ferofity
" was tranfmitted from the fplecn, betwixt the peritonaeum, and the mufcles
" of the abdomen."
But, to return to the fign taken from the navel, and the part which
lies neareft to it round about, fubfiding •, I mould, rather, in conjunction
with Refpingerus (r), whom I have already quoted, and whofe obferva-
tion, alfo, is an argument againft this fign ; I mould rather, I fay, believe,
that fome particular cafes had been confider'd, in which either the diforder
was not yet far advane'd, or, at leaft, wherein there was but a fmall quantity of
water. From whence vou may gather, that if thofe objections, which were
juft now made to this ifign, could not be of any force, yet that it would be
of no advantage, when the dropfy of the peritonaeum did not extend itfelf to
the region of the navel ; and, in like manner, of noufe at that time, in or-
der to diftinguifh thofe other included dropfies (as they are by no means
feated betwixt the mufcles, and the peritonaeum) from this of which I ani
fpeaking. And I fear the fame thing of other figns of the fame difeafe,
which are propos'd by men, in other refpects, very learned. They are
thefe.
If the belly preferves nearly the fame figure, although the fituation of the
body be chang'd. If the tumour has any peculiar circumfcription. If there
be any place of the belly, wherein if it be (truck on one fide, no ftroke, no
fluctuation are perceiv'd on the oppofite fide. But to begin with the laft,
and to take no notice that Nuck (s) has plac'd among the figns, or, at leaft,
among the good figns of this difeafe, " if the patient feels fcarcely any fluctu-
" ation." Hoechitetter (t) has remark'd of his patient, in the latter part of
his Scholium, that the great tumour of the belly, when ftricken with the
hand, gave forth a found like a drum •, but that " a fluctuation of water" had
been " never" perceiv'd : and Camerarius the father («) has faid, that not
even in the body of a woman after death, that is when we are at liberty to
handle the belly more freely, and to ftrike it with more force, did it feem to-
contain any thing fluid, rather than folid ; or, in other words, " no fluctua-
" tion was perceiv'd." This third fign, therefore, will be of no advantage,
except where we can obferve a fluctuation. And the fecond, which is taken
from the peculiar circumfcription of the tumour, will not be of any advan-
tage, when this dropfy fliall diftend the whole abdomen to fuch a degree, that
" the belly is pretty equally tumid, as the fame Camerarius obferves ; or
as Drelincurt faw (#) it, " equal, not acuminated, or tending to a point, in
•* any part, or protuberating here and there with little rifings."
But, when the tumour fhall appear to be bounded within a certain region,
it will not, for that reafon, be altogether plain, whether this tumour is from
a dropfy •, or, if from a dropfy, whether from a dropfy of the peritonaeum,
or of thofe parts, of which Nuck laid it was, when the tumour occupied the
(r) (.<) Cit. ad n. 50. (u) (.v) Ad n.50.
(/) Ad n. 47.
lower
Letter XXXVIII. Article 6o, 61. 347
lower region of the belly: although how high, unci to how great a breadth,
the dropfy of one tube may extend itfelf fometimes, that obfervation of Mun-
nickius, which is publifh'd in the Bibliotbeca Anatomica (y), fufficiently (hows.
I alt of all, in regard to thai firit flgri, it will-be, perhaps, of ufe, when
the water confiri'd in the peritonaeum, mall be as yet in very fundi quantity.
But when it has increas'd to fuch a degree, that the belly, as you fee in the
plate of Meekxenius (z), hangs down to the middle of the thighs, or almolt
to the knees, as Helwigius (a) defcribes it ; and even, on one hand, covers the
whole brealt, and, on the other, the legs, as Falfin reprefents {b) ; it is then
certainly not to be fuppos'd, that the figure of the belly is not chang'd, if the
lltuation of the body is chang'd. And as to the other figns which are added,
and are to be collected, after the water is drawn off by the lurgcon, by the
probe, by examining the parts with the hand, and by injection ; befides their
being too late, they are alio of fuch a nature, that they may indeed fcrve to
diltinguilh this dileafe from the afcites, but not from thofe other kinds of
dropfy.
60. Be cautious, however, of fuppofing that thefe figns, which I have hi-
therto examin'd, are difapprov'd by me. For I have only excepted the cafes
in which molt of them may be of no effecl:. But it can fcarcely happen,
that all of them are ufelefs in molt cafes •, efpecially if we attend clofely to the
fir ft beginnings of the dileafe, and accurately confider what was the face of
affairs at that time : as, for inftance, if the tumour fhall begin from the epigaf-
trium •, or if from the hypogaftrium, fhall neverthelefs be immoveable while the
woman lies down, and turns herfclf from one fide to the other, nor fhall give any
fenie of internal weight at the pubes, when the ftands upright, nor caufe any
difficulty in making water : although when the difeafe is advane'd, there may
be marks, from whence we may judge certain parts, fay the uterus, for inftance,
not to be affected •, that is to fay, if the menfes continue to be properly dif-
charg*d, we may conjecture that this. vifcus, the tubes, and theovaria, are not
opprefs'd with a dropfical, or other kind of tumour: or if the woman feel none
of thofe fymptoms which I mention'd juft now. In fine, the intention, and
ingenuity, of thofe perfons who firft deliver'd, down to us, the figns of dif-
eafes, are highly to be commended. Yet, at the fame time, it is our bufinefs
to compare together, a greater number of hiftories, both of difeafes, and dif-
feclions, than they had it in their power to compare •, that from thence we
may learn which of thefe figns may be us'd the moft fafely, and when : and, on
the contrary, which is lefs to be depended upon, and apt to lead us into
error.
61. Thus even in the cure of this dropfy, that is, the dropfy of the peri-
tonaeum •, in order to fay fomething on this head, alfb, as I have promis'd ;
what could be done by Tulpius (c), and Meekrenius (d), better than to extol
the paracentefis alone, which had been recommended by Walasus and Cofte-
rus, in a living woman, againft the dropfy of the peritonaeum -3 after having
(j) Tom. 1. in adnot. ad Graaf. de mulier. (a) (/>) Ad n. 50.
«rgan. ubi de oviduft. (c) \d) Cit. ad n. 49.
(x) Cit. ad n. 49.
Y y 2 examin'd*
348 Book III. Of Difeafes of the Belly.
cxamin'd the nature and feat of this diforder, by diffection. For without
doubt, on one hand, they faw that other remedies were of no effect •, and, on
the other, that this operation might be perform'd with the greateft expedi-
tion and fafety, as the vifcera were entirely feparated from the water ; and,
for that reafon, found : from whence there is no doubt but the long preferva-
tion of the vigour of the body, together with its capacity for action, is to be
accounted for, as I have faid already (e).
Other phyficians, and furgeons, influenc'd by the fame kind of reafoning,
came into this opinion ; Nuckf/), in particular, not doubting, but the rup-
tur'd lymphaedu&s may be clos'd again, in confequence of their being com-
prefs'd, betwixt the mufcles of the abdomen, which contract themfelves, and
the laminae of the peritonaeum •, which in an afcites, that has its origin from
the rupture of lymphatic vefTels, can by no means take place; and produc-
ing two cures of the dropfy of the peritonaeum, which were brought about
in this way, one of Amicus, and the other, which he fuppos'd to belong to
this clafs, from Thomas Bartholin : to which he would, moreover, have added
others, if they had then exifted; as that which the celebrated Degnerus (g)
has given the hiftory of, where the diforder was in the lower part of the ab-
domen, on the right fide : and ftill more, that which Brehmius, whom I
have already commended (£), relates •, when the dropfy was in the whole ab-
domen, and which nature herfelf perform'd, by a great difcharge of clear wa-
ter in the former cafe •, and, in the latter, by a great difcharge of limpid, and
inodorous ferum.
But after it was obferv'd, that the peritoneal fac was not always fo dif-
pos'd, as it was feen to be by Tulpius, and Meekrenius, but was, fome-
times, fo affected with tumours, abfcefies, and ulcers, that though the wa-
ter might indeed be drawn off, the fources of this fluid, nevertheless, and the
pus, could not be fo eafily dried up •, and that, for this reafon, a matron of
whom Littre (/), and a woman of whom Laubius fpeaks (k), could not be
fav'd, although the former had the water drawn off thirteen times within
two years, and the latter fixteen times within ten months •, fo that the whole
quantity of fluid, difcharg'd by this laft woman, amounted to more than
feven hundred and twenty pints : then this method of cure did not feem to
be, always, fo expeditious, and fecure, as it had at firft feem'd ; nor was it
without reafon, and juftice, that they chang'd their opinion. And that this
will appear the more reafonable to you, I do not doubt, as there are fo
many of the obfervations I have produc'd above ; and thofe even from for-
mer times, wherein thefe diforders of the peritonaeum were not wanting.
Therefore, befides thofe women, whole ftrength is already broken down,
who were the only fubjects excepted by Tulpius, and thofe whom Nuck had
excluded afterwards, for various reafons, indeed, but all referable to the fame
head nearly ; Littre has moreover prudently added others, admonifhing us
with how much danger of an unfuccefsful event, we undertake the cure of
thofe women, in whom not only the difeafe is very inveterate, and very much
(e) N. $8. [h) Vid. fupra. n. 59.
(/) Cit. ad n. 50. . ■(*) (i) Cit. ad. n. 50.
(g) Act. 11. c torn. 5. obf. 2.
extended,
Letter XXXVIII. Article 62. 349
extended, but thole alio in whom the water which is drawn off is thick, of a
bad fmell, and a deprav'd colour •, and in whom any tumour, or hardnefs,
that is when the water is evacuated, is perceiv'd in any part of" the peritonaea!
lac. And this fign was afterwards manif'eft in the woman of" Laubius, and
another alio, which ought to be added here j I mean that the right fide being
prick'd, nothing but pus was dilcharg'd, while from the other, which was
prick'd at the fame time, water flow'd out. However, theft two laft men-
tion'd figns relate to fore -knowing the event of the cafe, when the cure has
been already undertaken, and not to the propriety of attempting it.
62. But before you even undertake to attempt a cure, I would have you
enquire, accurately, whether there was any hardnefs, or tumour, before,
which the great detention of the abdomen now hides ; and befides, whether the
patient is troubled with any confiderable pain (I do not mean that which the
diftention itlelf produces, but that which arifes from an ulcerous erofion of
the teftis) or, at lcaft, whether pain is excited in any part of the abdomen,
when you prefs it pretty clofely with your fingers. It does not, however,
efcape me, how happily every thing fucceeded with Chomelf/), even in a
great fuppuration, and a certain erofion •, but both of them recent : nor what
Littre (;;;) propofes againft thefe ulcers, firft by injections, and after that by
fkilful comprefiions, and bandages •, and even againlt tumours, by cutting
into them from above, and applying certain methods of cure. I know, alfo,
that the water was drawn off by Laubius («), not with a view of curing, but
of eafing the patient, where there were purulent tumours.
But I am not fpeaking, here, of profecuting cures which are begun by na-
ture, or by art, but of attempting them at large ; and without a proper hope
of bringing them to perfection. You, therefore, will avoid thofe patients,
alfo, which I juft now added, when it is in your power. Yet there are, be-
fides, thofe in whom the tumours are not altogether hid by the diftention of
the abdomen ± either becaufe there is as yet a lefs quantity of water, as in
the fecond of the obfervations that I have produe'd (0) ; or even becaufe the
water, or any other matter of a thicker nature, is not contain'd in one con-
tinu'd fac, but is divided into many cavities ; fo that fome are more turgid,
and others lefs fo : fuch as were found in the direction of a midwife after death,
by Camerarius the younger (p), who very prudently objected to performing the
operation of paracentefis, which had been recommended by another; becaufe
he had obferv'd " the bulk of the abdominal tumour to be unequal, and to
" give a different degree of refiflance in different regions." And what
could the parancentefis have done in this cafe, or even in that which Gahrli-
epius (q) had defcrib'd ?
For ^the matter, whether fimilar to gluten, or to the fpawn of frogs, does
not evacuate itfelf by the infliction of a pretty large wound ; not to fay by the
ufual foramen : and if it be thin, even very thin, where it is feparated by
many partitions, as it was in both of thofe obfervations, although it fhould
be difcharg'd from one cavity, which you have perforated, it does not, for
that reafon, come out of the others ; and therefore the fame thing mufl of
(I) (m) (») Ad n. 50. (p) Aft. n.c. torn, l.obf. 160.
(0) N. 52. (7) Cic ad n. 50. •
4 courfe
350 Book III. Of Difeafes of the Belly.
courfe happen here, that I faid happens in an afcites (rj, when that is
made up of hydatids, which are, alio, connected with each other. And as I
fee that this cafe is reckon'd among the various kinds of afcites, I was not
willing to pafs over this " encyfted dropfy," as it is call'd by obfervators,
on the preient occafion. For although it differs in its matter, and in its
partitions, from the more frequent dropfy of the peritoneum, yet it is ge-
nerated in this membrane : nor ought we to omit the mention of it, because
it is only a rare cafe, but rather take particular notice of it, for that reafon ;
left when it is at any time met with, it fhould be again improperly con-
founded with the afcites, or with the other more known dropfy of the peri-
tonaeum.
63. And indeed I cannot help thinking it very proper to take notice of
other dropfies, that are encyfted in like manner, before I make an end of
writing. There are fome thus call'd by thofe who give the hiftories of then;,
which, neverthelcfs, belong to the more frequent dropfy of the peritonaeum ;
as that on which the celebrated Schcfflerus (jjpublifh'd a differtation, in which
he is of the fame opinion with me (1) •, I mean that a great quantity of ferum
bad been collected " within the duplicative of the peritonaeum," and had, by
this means, form'd a fac, upon which a large fteatoma was generated. But
others are of a difFerent kind, as that defcrib'd by the celebrated Anhornius
(«) •, an almoft incredible quantity of fluid being confin'd betwixt the perito-
naeum, and the omentum, which was become very hard, in a woman whole
" face, confidering her emaciated ftate of body, was of a pretty good colour,
" and whofe feet free from fwelling :" which kind of figns, and others like-
wife, I fhall not omit to mention from time to time, that you may compare
them with my former doubts and hefitations (*).
So, alfo, the younger du Verney (y) relates, that a woman, of thirty years
of age •, who had begun to have a tumour in her belly feven years before,
was of a good complexion, had a good appetite, and flept well, and was as
yet very ready and alert in her actions •, had, on opening the abdomen after
death, a large fac therein containing many cells, not at all communicating
one with the other, each of which was filled with a peculiar matter, quite
different from the reft : which agrees very well with his account, that a fe-
rum of a different nature had been drawn off at different times. And the
fame author diffected a woman with an afcites, in whofe belly he found, be-
fides, a large cyft full of redifti ferum. There are alio encyfted dropfies, in
regard to which it does not well appear, from the anatomical defci iption,
whether they belong to the firft or fecond clafs •, as you will eafily believe,
from reading what is written of the fac, which was feen in a certain virgin
fz), who had been taken off by a very fudden death, after the difcharge
of the water.
64. And although I fhall write fome things, in the next letter upon the
dropfy of the ovarian, yet, as this, alfo, is enumerated among the encyfted
dropfies, I will rather here hint at fuch remarks, as you may readily join
(r) N.45. ' WN.57.
(s) Hift. h^dr. faccat. (j) Mem. de l'acad. r. des fc. a. 1703.
(:) §. 4. (x) Eph. n. c. cent. 7. obf. 17.
{«) Eph. n. c. cent. 9. obf. 100. n. 7.
with
Letter XXXVIII. Article 64. 351
wirh thole which I had occafion to make before (fl), upon the fame difeafe:
left in the next letter I fhould be more prolix, or lei's clear, than is ne-
ary.
Some obfervations of this difordcr, like-wife, are certain, and others doubt-
ful. I will produce examples of each kind, which you may add to the Scpul-
chretum. Among the certain obfervations of this dilorder, either in its be-
ling, or when it had made but little progrefs, are thofe made by Came-
carius the fon (£), by Goetzius (t), by Maggi and Dodi (d). The firft of
theft gentlemen io\\m\ a humour in the ovarium, to the quantity of four
ounces-, the fecond to the quantity of three pints-, and the two laft to the
quantity of three pints and a half: and the iame obfervers (for the two firft
had heard nothing of the figns relating to the dilorder that they could remark)
found out, by inquiry, that the woman had often complain'd of a weight,
which Hie perceiv'd in the lower part of her belly, in fuch a manner, that
on whichever fide ihe lay, on that fide the weight lay ; and when (lie turn'd
herfelf to the oppofite fide, the weight was transfer'd thither like wife.
But thofe of whom Riedlinus (e), Vacher (/), and Schacherus (g), have
written, after that in each of them the ovarium, and the belly, had already
grown out into a furprizing tumour, gave thefe relations neverthelefs ; the
firft of them, that her belly had begun to fwell on the left fide ; at which
time (lie had conceiv'd, notwithftanding this affedtion, and was happily de-
liver'd, being alert, fprightly, and robuft, even in the latter part of her dif-
eafe-, inaimuch as, except the tumour of her belly, which was troublefome
to her, Ihe had nothing that gave her the lead uneafinefs : the fecond, that
fix or feven years before, fiie had firft of all felt a pain in the hypogaftrium,
on the left fide : the third, that fome years before, a pain in the belly,
which fhe did not know how to explain, had been the beginning of her
evils -, that after this, a tumour being form'd by degrees, the weight of it was
us'd to fall on that fide, to which the fituation of the body inclin'd it.
Thefe two, as well as the firft, had found no advantage, or alleviation, from
medicines of any kind whatever : but they had not, like the firft, fuffer'd
very little inconvenience, particularly in the latter part of the difeafe, when
they were unable to reft in their beds, except they fupported themselves on
their bended knees, and, inclining their bodies forwards, laid their heads
upon the bed that was under them : which kind of pofture was obferv'd by
Schefflerus (£), to be neceffary, in fome meafure, to the woman he fpoke
of, in order to incline her to fleep : but this woman labour'd under a dropfy
of the peritonaeum ; and the three, of whom I am at prefent fpeaking, under
a dropfy of the left ovarium -, which being ruptur'd, here and there, in the
third woman, had join'd an afcites to itfelf over and above, juft as it hap-
pen'd in that widow who is defcrib'd by the celebrated Baflius (z), and in an-
other woman, who is fpoken of by the celebrated Guttermann (k).
(a) N. 58, 59. (f) Hifc. de 1'acad. r. des fc. a. 1739. obf,
(&) In obf. 160. ck. fupra ad n. 62. anat. 3.
(c) AS., n. c. torn. 2. obf. 207. {g) Din", de virgine afcitica §. 10. 13. &ca:t.
(d) Apud Vallifner. iJtor. della generaz. (/>) Ck. n. 63.
3. c. 5. & tab. 12. (i) Dtc. 4. obf. anat. 8.
(?) Eph. n. c. cent. 7. cbf. 56. (k) A&. n. c. torn. 3. obf. 105.
Others
352 Book III. Of Difeafes of the Belly.
Others have been more happy under this tumour of the ovarium, though
increas'd to the higheit degree •, as the virgin of whom Gullmann (I) relates
that {he had, nevertheless, for fifteen years, " enjoy'd perfect health •, for her
" menfes were regular-, " flie had a good appetite, flept well, &cj" except
that, in the two laft years, fhe was frequently feiz'd with fwoonings : and,
in like manner, as two women who were dififected by Jo. David Mauchartus
(»*)• In what ftate thefe patients were, for more than feven years, during
which time, if you except almoft the laft weeks, they were never under a ne-
ceflity of confining themfelves to their beds, you may conjecture from the
words which he premifes to the obfervation : thofe dr^plical women who
M are neither pale, but rather preferve a rofy colour in their cheeks, nor have
" a tumour of the feet, 16 that they rather grow lean, and (lender, in their
" limbs, and the other part of their body, notwithftanding the abdomen is
" increas'd every day ; thefe women, I fay, if they carry this load about
" them for a long time, without any confiderable injury to the actions of
" the body •, if they have a good appetite, are not very thirfty, nor have a
" cough, but theinteltines perform their office properly, the urine is of a na-
" tural colour, and the tumour of the abdomen neither gives way to purging
" nor diuretic medicines •, and efpecially if the dilbrder takes its origin from
*' a difficult birth, or an unfortunate time of child-bearing, from a falfe con-
" ception, or abortion, without other concurring figns of a cachexy •, are
" always affected with a dropfy of the ovarium, or that which is call'd an
" encyfted dropfy."
But thefe words of this very eminent man, if we underftand them fo as
to fuppofe them referable to no other dropfy but that of the ovarium, are
contradictory, you fee, to thofe things which are fhown above (n), in regard
to fome other patients, and will be mown below. Moreover, as to the figns
of that dropfy, the celebrated Trew (0), when he propofes his obfervation
thereof, fays there were, among thofe that examin'd the abdomen of a liv-
ing woman, fome who " pronounc'd that there was an encyfted dropfy ;"
and others who, " becaufe no fluctuation could evidently be perceiv'd, upon
** ftriking the belly, call'd it into queftion :" and then enquires, " whether
** when the abdomen is expanded into a preternatural bulk, is, at the fame
14 time, ponderous and heavy, but a fluctuation cannot be very accurately
•* perceiv'd, by a percuflion of the belly •," he inquires, I fay, " whether
M we may reafonably conclude from thence, that the difeafe ought to be
" call'd a dropfy of the ovarium, rather than an afcites ?" The celebrated
Targioni (p) however ; who law a very great dropfy of the ovarium, if any
other man did, and has written accurately, and learnedly, upon this difeafe ;
when he gives the hiftory of a matron, who was afflicted with this diforder
four and thirty years, from the beginning to the end, being troubled with
an exceffive difcharge of the menftrua, as long as her time of life permitted ;
and, finally, with frequent vomitings, and fome difficulty of breathing, in
going up ftairs, and being extenuated in the upper part of her body, but
(/) Eorund. t. 2. obf. 80. (0) Comerc. litter, a. 1734. hebd. 44.
(m) Eph. n. c. cent. 8. obf. 14. (/>) Prima raccolt. d'offerv. med.
(«) N. S8. 59.
having
Letter XXXVIII. Article 65. 353
having a good appetite, and being able to (land, even to the very laft week
or" her lite, and to move herfeif as flie plca.-Al ■, and, what is ftill more fm-
prizing, to lie down on either fide, or in a limine pofture, and with her
head low, without any inconvenience -, relates that the fame woman, both
while (lie was living, and alter death, was known to have her belly full
of water by the touch : as a fluctuation was very evidently perceiv'd, even
by linking it gently with one hand, while the other was applied to the
oppofite fide, jult as it happens in patients who have an afcites.
Nevertheleis, the fac filPd the whole cavity of the belly : and the water, which
was computed to be in the quantity of about a hundred and fifty pints, fill'd
the whole cavity of the iac to fuch a degree, that upon making the flighteft
puncture into it with the knife, the fluid burft forth with the grcatett im-
petus. Is this difference to be accounted for from hence, that in the wo-
man fpoken of by Trew, the water was divided into many cells •, but, in the
matron fpoken of by Targioni, was contain'd in one cavity, lb that nothing
prevented the fluctuation being communicated ? I fhould perhaps have made
this conclufion, and not without fome advantage in the cure of the diforder,
as will be fhown hereafter (q)y if Camerarius the father, when he could per-
ceive no fluctuation, as is faid above (r), had made any mention of cells be-
ing found in his large fac. You will inquire more accurately into thefe
things, not only in the writings of the authors whom I have mention'd by
name, but alio in the writings of thofe whom I have without doubt omitted
(s) •, among whom the celebrated Benevolus (/) ought to have been parti-
cularly confulted by you, if he could have defcrib'd the other circumftances,
with the fame accuracy, wherewith he defcrib'd that large fac, into which the
ovarium had expanded itfelf.
65. Hitherto I have taken notice of thofe obfervations, which are, be-
yond a doubt, to be refer'd to the dropfy of the ovarium. I will now fub-
join fome, according to my promife, in regard to which you may be in doubt,
whether to clafs them with the others. You will read two of the celebrated
Jo. Mart. Brehmius («), in the firft of which a great fac, full of water, that
the patient had been troubled with for fourteen years, was " very clofely
" connected " to the urinary bladder-, and in the fecond a fac of the fame
kind which had troubled the woman for two years " was grown into one fub-
" itance with the fundus uteri, towards the left fide ; where it feem'd to have
" taken its origin, by the means of various ducts and canals." As no men-
tion is made of the ovaries, or tubes, no more than in a certain hiftory which
was publifh'd five and thirty years ago, in the two cities next to this, as if
of a dropfy included in the uterus, whereas the uterus did not contain the
water, as it ought to have done •, and as you may fee, in particular, in the
obfervation of Henricus Alb. Nicolai (#), wherein a large cyft, diftended
with water, rais'd itfelf up from the left fide of the fundus uteri, quite to the
diaphragm ; I lie under a necefilty of doubting in this cafe, although I am
not ignorant that Riedlinus (y) has, with good reafon, fuppos'd " a dropfy
(q) N. 70. (u) Aft. n. c. torn. 6. obf. 94.
(r) N. 59. (*) Dec. obf. illuilr. anat. obf. 9.
(s) Vid. epiir. 65. n. 17. \y) Obf. 56. cit. ad n. 64.
(t) Offer vaz. 9.
Vol. II. Z " which
354 Book HI. Of Difeafes of the Belly.
" which is faid to be uterine, to have its origin and feat, for the moft parr,
" in the teftes ; from whence thofe facs, which are frequently fo large, and
" contain fo large a quantity of water, and cover all the inteftines .... are
" deriv'd."
But the younger du Verney (z) found two large cyfts of that kind, rifing
from the left fide of the uterus, and embracing the ovary •, but, in one of
the women, not dilated, as he fays, and fhut up within another cyft of a
larger fize : in the other, dilated, but not at all in proportion to the magni-
tude of the cyft in which it was comprehended. I fliould, perhaps, have con-
jectural that the external coat of the ovaries, expanded by water, had made
thefe large cyfts, if he had not faid that they role from the fide of the uterus.
66. There are, alfo, inftances of a dropfy that relates to the tuba Fal-
loppii ; fome of them, like the former, certain, and others doubtful. In the
number of the certain ones I reckon that which was fent from Munnickius,
and publifh'd by the compilers of the Bibliotheca Anatomica (a). For it is
fufficient to look at the figure, in order to be convinc'd that the right Fal-
loppian tube had dilated itfelf, fo as to contain a hundred and twelve pints of
water, under which difeafe the unhappy virgin labour'd eighteen years.
Nearly equal to this, was that dropfy of the tubes which Siboldus has de-
fcrib'd ; but that defcrib'd by Cyprianus ftill larger, as far as I can judge from
the Afta Erudiiorum Lipfienfta {b) -, for neither of thefe authors was in my
hands when I wrote thefe things. Nor do I doubt but the dropfy of the
cornua uteri was really in the tubes, when I examine the figure given by
Tulpius (c), who defcribes it ; which, as well as that of Munnickius, and
others alfo, is wanting in the Sepulchretum. And I wifh, with all my heart,
that Sponius, whofe obfervation I have quoted above (d)y had join'd a de-
lineation therewith; for he would, by that means, have taken away a fcruple
from me, which a defcription cannot remove.
He looks upon his fac as a dilatation of the tube, and he defcribes the
tube as embracing the ovarium, and carried upwards from thence, " to the
" extent of half a foot higher than the natural fituation thereof requir'd •" as
the fac reach'd quite to the enfiform cartilage. But the tube is generally pro-
duc'd, on the furface of the fac, beyond its natural extent •, not when the
tube itfelf, but when fome other neighbouring part, as, for inftance, the
ovarium, is dropfical : as du Verney (e), and Targioni (/), have fufBciently
feen ; and as Schacherus (g), and Maggi and Dodi (h) have even deli-
neated. Therefore, fince Sponius does not at all reprefent the ovarium as
being dropfical ; and complains that the incautious furgeon, by a hafty dif-
fecYion, had cut into the peritonaeum, together with the mufcles •, I fuppos'd
that this dropfy might be number'd among the other examples of a dropfy of
the peritonaeum (*').
But if it feem otherwife to you, and you choofe to take away this, or any
other example, from thence, which I have no objection to your doing, a fuf-
ficient number will ftill remain there. But to what clal's fhall 1 refer the
(z) Meai. de l'Acad. R. desfc. a. 1703. [d) N. $0.
(a) Cit. fupra ad n. 59. (:) (f) (g) {b) Cit. fupra ad n. 64.
(b) A. 1685. m. April & a. ijoi.m. Febr. (/') N. 50.
(<•) Obf. med. 1. 4. c. 45.
4 obfervation
Letter XXXVIII. Article 67. 355
obfervation of Roliinc (k)% who found the left ligament of the uterus dif-
tended with water, to fuch a degree, " in the upper part," as to " occupy
M the whole cavity" of the belly ? Can \vc fuppole that one fo well flcill'd in
anatomy as he was, it he had fcen a dilatation of the ovarium which was
annex'd to this ligament, or of the tube, would not have taken notice of it ?
Or mall we take for granted, that there is a peculiar dropfy of this ligament,
owing to water being collected betwixt its two membranes, befides the oilier
droplies in the parts that lie near thereto ? This appearance he faw in a wo-
man, who, notwithltanding her abdomen had grown out into a great bulk,
and me had been without any menftrual difcharges, for the whole fpace of
three years, had, neverthelefs, a good appetite, and went about her houfhold
affairs as uiual, though with fome difficulty, till me was carried offfuddenly ;
as another woman, fpoken of by Brehmius, was alio (/) ; who, however, had
her heart incrcas'd very much in its fize •, and the matron mention'd by Tar-
gioni : for I do not remember, at prefent, out of all the examples of difeafes
of this kind, that I have taken notice of, any others befides thefe three, who
have died unexpectedly.
6y. Now if you attentively collect, in your mind, the figns that I have
mention'd from time to time, as I reckon'd up the obfervations of almoft
every one of thefe dropfics, you will certainly obferve, how much they agree
one with another, and with the dropfy of the peritonaeum •, and will under-
ftand, that if the great bulk of the belly has already continued a long time
(du Verney the younger (m) requir'd more than the fpace of two years from
the firfl beginning:) if the tumour has increas'd, by degrees, as in gravid
women, without much inconvenience, and without any, or, at lead, without
a great change of colour in the fkin : if purging and diuretic medicines have
afforded no alleviation : if the lower limbs have not become tumid, till the
latter part of the difeafe : if there are thefe figns, I fay, you will underftand
that the woman does not labour under an afcites, but, generally, under fome
other confin'd dropfy : and yet it does not, ofcourfe, follow, that fhe does
not then labour under an encyfted dropfy, though any one of thefe marks
may be wanting.
For there have ever been fome, who complain'd of internal pains of the
belly for inftance, that is, in confequence of the vifcera, and particularly the
inteltines, being comprefs'd by the neighbouring weight, and diflention of
the fac ; this fac being more fix'd, or prominent, in a certain place ; which
you eafily perceive muft happen more frequently, in the dropfy of the ova-
rium, or any fimilar part, than in that of the peritonaeum. And there may
be fome, though this is much more extraordinary, to whom the medicines
that are adminifter'd may give a little relief, if they happen to difcharge
water ; not that which is included in the cyft, but that which is extravafated
into the cavity of the belly : for that this was, fometimes, the cafe alio,
though the water was generally in a fmall quantity only, has been remark'd
by du Verney, whom I have already quoted ; and he obierves that it happens,
at the time when the cyft can admit of no more water : from whence he fays
(i) Sepukhr. fett. hac 21. obf. 61. & 55. (/) Cit. fupra n. 65.
$. 24. (m) Cit. ibid.
Z Z 2 it
356 Book III. Of Difeafes of the Belly.
it is, that the lower limbs do not fwell, till very late in the difeafe, as I
have already laid.
But in regard to the figns, by which you may diftinguifh the dropfies in
queftion, from each other, you yourfelf muft perceive that there is nothing
which you can expect from me-, for there is fuch a propinquity betwixt the
ovaria, the tubes, and the ligaments, by which they are connected together,
and fuch a necefiity for the functions of them all, in the work of generation,
that it is out of our power to gather any certain inferences either from the fitua-
lion of the tumour, or from the faculty of generation in the woman being im-
pair'd, which of thefe parts is dropfical. And indeed if the woman fhould con-
ceive, in the mean time, you cannot from thence argue, that thefe parts are not
affected ; for you very well know it to be fufficient for this purpofe, that they
are found on either fide. Yet however, you will naturally fuppofe that fome
one of them, and particularly the ovarium, as this is moft frequently the
part affected, may be fwell'd, when the beginning of the tumour (hall dif-
cover itfelf in the feat thereof. You will fuppofe that it may be fwell'd, I
fay •, for the tumour may even be there, and yet not feated in thefe parts.
We muft, then, alfo, confider whether the tumour may not be of ano-
ther kind ; as, for inftance, when Gandolphius (») found each ovary equal in
magnitude to a man's head, and more than five pounds in weight, but of
one and the fame compact fubftance every where ; or when he faw the fame
kind of diforder, in one of the ovaries of another woman, which weigh'd
about fifteen pounds : but even tumours of another kind occur, not very
rarely, in the fame fituation, in particular the fteatoma (which kind has been
found by me (0) ) •, and this, as Schacherus (p) has admonifh'd us, fometimes
may be taken for a dropfy of the ovarium. You, however, by diligently
weighing all the fymptoms that have preceded, and accompany the difeafe,
•will more readily iufpect the tumour to be of a dropfical kind, when the
temperature of the body, the diet, and difeafes have been, or are, of fuch a
kind, as to difpole women to dropfies. And by what reafonings you ought
rather to fuppofe the water to be collected betwixt the mufcles, and the peri-
tonaeum, than within this membrane, I have endeavour'd to fhow you above
(q), as far as is pofiible in diforders of this kind : and if any thing (hall occur
to my mind, in the mean time, either by reading, or thinking, that may
tend to diftinguifh other dropfies, even by the flighted conjecture, I will not
omit it in the next letter (r).
68. But if it is difficult to determine the nature of thefe dropfies, of which
I have fpoken, it is (till more difficult to cure them. Nor would I have
you fay that nature itfelf has fhown in what way this may be done, when fhe
reftor'd to health the woman of whom Brehmius (s) writes, by difcharging
a fluid through a very fmall foramen, every other day, as I have already laid.
For that dropfy feems to have been in the peritonaeum, as it really was when,
according to the relation of Anhornius (/), nature attempted the fame way
three times; and, at firft, with advantage, yet afterwards unfuccelsfully. But
(«) Hift. de l'Acad; R. des fc. a. 1707. obf. (?) N. 60.
anat. 4. (r) N. 40.
(0) Supra n. 34. {s) (/) Cit. fupra ad n. 59.
(p) Diif. fupra ad n. 64. cit. §. 13.
as
Letter XXXVIII. Article 68. 357
as I have fpoken above of the cure of the dropfy in the peritoneum, I in-
quire, here, after the method of cure in thoie dropfies, which are included in
a fac or cyft, and contain'd in the cavity of the belly. The younger du
Verney '«/, who was a furgeon as wcll-experienc'd in the operation of para-
centefis as any one whatever, exprefsly denies his having ever fcen any one
cur'd, who was afflicted with an encyfted dropfy ; and, what is more, afterts
that he had feen many women, who being troubled with no other difagree-
able fymptom, but that of a cumberous belly, and being defirous to get rid
thereof, by having the water taken away, had been carried off in a fhort
time •, whereas they might, otherwife, have liv'd long, and fometimes very
Jong, as the examples frequently pointed out demonftrate. And feveral others
have likewife feen that fpeedy death has often been the confequence of para-
centefis in thefe dileafes.
Nor is it to be wonder'd at : for nothing more frequently happens, than
that the air, being admitted to the water, which is of itfelf, already, of no
good nature, as its brown colour, for the moft part, fhows, or to the parts
of the fac which are already lax, vitiated, and ulcerous, foon brings on fatal
changes. For from hence it chiefly happens, that although, at firft, the
patients feem to themfelves, and to others, to have received much alleviation
from the operation, yet inftead of that kind of water which was firft drawn
off, and was not of a very deprav'd nature, that which was taken away the fe-
cond, and the third time, or flows out afterwards, may be green, or black,
or turbid, faeculent, and fomewhat bloody, or of a very bad fmell ; and,
finally, not without purulent matter, as you will eafily learn from reading
over the obfervation of the furgeon laft-quoted, made on a woman of thirty
years of age, and on a virgin of fixty, one of Riedlinus (x), and one, and ano-
ther, of Anhornius (?), made upon three women. And what do you fuppofc
muft happen, when the water is either already, of itfelf, purulent, or foetid ?
Tuipius (z) faw nine pints of water, and pus, in the tubes. In the ova-
rium, Maggi and Dodi (a) found a foetid humour. And what will you
luppofe muft be the confequence, when the internal furface of the fac is
full of abfcefTes, as du Verney found it. Moreover, even though the water
may neither be purulent, nor foetid, and the fac without abfcefTes, it certainly
has, very often, either hydatids fix'd to it internally, or water, or fome other ~-^~
matter, divided into many lefler facs : from which circum fiance it happens,
that the water being drawn off from one fide, the lwelling of the abdomen
is not remov'd on the other, or the flowing out of it foon ceafes ; and if the
furgeon then forces on the cannula, he feels an obftacle to its paffage : what
is to be done then I would be glad to know ? Are all the feparate facs to
be open'd ? Trew fb) found it neceffary to open the membranous intercep-
tions of the lefler lacs, " more than ten times," in order to draw out all the
water from the larger fac, which contain'd ail the others.
But muft we make ufe of the fame method to obtain a cure in the living
body, as we do to examine into the diforder after death ? Or ir it were pro-
per fe to dor would it be in the power of any furgeon to fee the leffer facet1, h
(u) Cir. adn. 65. (z) Cit. ad n
(x) Eph. n. c. cent. 5. obf. 67. fa) Ad n. 64.
(y) Eorcnd. cent, c^obf. ioo. n. 3 & +. (b) Ibid.
wh
358 Book III. Of Difeafes of the Belly.
which lie hid within the deep cavity of the belly, and pierce through each of
them feparately, without wounding any inteftine, or other neighbouring
part, at the fame time ? Befides, what if there mould be innumerable hyda-
tids, as I faid there frequently are ? What ? If all the cells mould not con-
tain water, but fome a matter like cheefe, or like a pultice, as in the obler-
vation of Miegius (c) : What ? If a large fcirrhus were feated there, over
and above, fuch as was feen by du Verney. Other confiderations I omit ; for
from thefe you already fee, with fufficient clearnefs, why this paracentefis
muft happen to be not only ufelefs, but even hurtful, to the miferable woman.
6g. But fuppofe even that there is only one fac, and that this fac is not di-
vided by any partitions, as, befides Maggi and Dodi (d), Vacher (e), Bene-
volus (f), and Targioni (g ), have found it, and not vitiated with abfcefles,
and tumours •, (for Benevolus obferv'd globular bodies prominent inwardly,
fome of which were even larger than eggs, and Targioni a farcoma of the
bignefs of a kidney, which hid fmall abfcefTes in itfelf ) : finally, fuppofe that
there are no cells, which contain a different kind of matter; and that the
water which is contain'd is not of a very deprav'd nature. What follows
from hence ? Do you think that the cafe would be then a fair fubjecl for
the operation ? Targioni fays not. As he fears, not only left the omentum,
which is interpos'd, or the inteftine, or fome other vifcus, fhould be wound-
ed, and left a part of the water fhould be pour'd out from the perforated
fac, into the cavity of the belly ; the latter of which he fays may, however,
be avoided, if the woman lie in a prone pofture ; but he is particularly afraid
of thofe confequences, which Schorkopffius (b) was formerly afraid of, left
the membrane of the evacuated fac contract a gangrene ; or, at leaft, a fup-
puration ; chiefly on account of the air being admitted-, or if it does not con-
tract either of thefe difeafes, left, like other folliculated tumours, it be again
fill'd with its proper humour, that is with water.
To me it certainly happen'd that, while I was revifing thefe things, I was
confulted by a barren woman ; who having had a distention of the abdomen,
for a year before, not without a very great refiftance, on the left fide thereof;
and having us'd the afliftance of phyficians in vain ; found, all of a hidden,
about the lpring of this year, that while fhe happen'd to laugh, and (hake
her belly with great vehemence, fomething burft afunder therein, with
a kind of a crack ; and it immediately became fofter, at the fame time that
Hie felt an unufual weight, in the lower part of the abdomen, with a fen-
fation (which had never been before) of fluctuation, and of a certain weight
falling down to that fide, on which fhe turn'd herfelf. And thefe fymptoms
having difappear'd, by the help of remedies which difcharg'd a great quan-
tity of ferum, by the kidnies, and inteftines, the woman feem'd, to herfelf, to
be in very good health for fifteen days, but no longer.
For after that time, the abdomen return'd again to its former bulk, and
tenfion; (he being of a good colour in her face, as (he always was before ; her
feet not being tumid : and, except certain pains of the belly, which were
troublefome at intervals, the large bulk thereof, and the diminution of her
(<■) Aft. n. c. torn. i. obf. 85. (/>) Diflert. de hydr. ovar. th. 25.
W to if) (g) Cit. ad n- 64.
menftrua,
Letter XXXVIII. Article 70. 359
menftrua, all which circumftances had alio been obferv'd before, (he was agile
in her body, robuft, and in extreme good health. That the cyft, therefore,
after difcharging its original fluid, fhould not be again diftended with a
frefh one, it would be necefiary, if poflible, to confume, or extirpate it en-
tirely ; as is done in external follicles. But who could propofe, or even bear,
the firft of theie operations on a large fac that is hidden among the vifcera ?
The iecond, indeed, I know has been propos'd by fome, who were en-
courag'd thereto, by that Well-known, but very rare, cure of Abr. Cypria-
nus : yet whether any one has made the trial within thefe thirty years, or
more, fince it was propos'd, 1 cannot determine.
What might be the caufes to prevent them, it is not difficult for you to
conceive : to omit the greater part of which, if the cyft were always fupported
by one root alone, on which a ligature might eafily be made-, as in the ob-
fervation of Mauchartus (/), or in that of Schrbckius (k) ; you would, per-
haps, begin to give ear to the propofition. But What ? If there were more
roots than one,- or if there was one very broad, and not, as it was with them,
" very narrow," or " of the thicknefs of a man's thumb :" what ? If the
cyft mould be connected to one part, and to another, and even at a great
diftance from that part of the abdomen, which, in imitation of Cyprianus*
you would cut into. Yet this author had learn'd from an ulcer, through
which he could feel the carcafe of a fcetus, which had lain there twelve
months, in what part it was to be cut into •, juft as Degnerus (I), if a large
dropfical tumour, by burfting afunder betwixt the peritonaeum, and the
muicles, had left not a large, but a narrow pafiage, could, likewile, very
well know, by introducing a probe, which way it might be laid more open
with the knife ; fo that a cyft bigger than an ox's bladder, which came
away of itfelf, might be extirpated by the iurgeon.
70. Muft we have no hopes then, you will fay, of a cure in an internal in-
cyfted dropfy, becaufe it is not poflible, either to confume, or extirpate, the
cyft ? The younger du Verney (»?), neverthelefs, hop'd for either a perfect:
cure, or a great alleviation, if at any time after the water was drawn off, the
parietes of the cyft, when collaps'd, fhould coalefce with each other ; and by
this means fhut up the extremities of the veffels, by which the water was
carried thither : and this he fuppos'd to have happen'd, in a virgin of
twenty years of age, whofe belly had begun to iwell almoft two years
before, without any change in the colour of the fkin : and, in like manner,
in a widow-matron, who, being now advane'd in age, had been afflicted with
a furprizing tumour of the belly for fix or feven years : from both of whom
having taken away the water, he fo perfectly cur'd the firft, that fhe married,
and brought forth children 1 and gave great eafe to the other, and long free-
dom from the dilorder, as fhe perceiv'd nothing of it for more than two
years together, till, by degrees, the belly return'd to its former magnitude.
But he thought it necefiary, that the cyft fhould be loofe, and unconnected,
even at that time, as the uterus is in pregnant women •, without doubt, fear-
ing, left, if it was connected here and there, the parietes fhould be, fo much the
(/) Cit. ad n. 64. (I) Cit. fupra ad n. 61.
(k) Eph. n. c. dec. 2. a. 8.obf. 233. (mj. Cit. zd n. 65.
360 Book III. Of Difeafes of the Belly.
more, prevented from approaching one to another, and coalefcing. He alfo
thought it ncceflary, as I fuppofe, that there fhould not be more than one
cavity in the cyft •> which otherwile muft be an obltacle to the coalition. But
I could wifb he hadexprefly requir'dit : for, perhaps, as he certa;nly iuppos'd,
that the cyft might be conceiv'd, by every body, to be unconnected, if it
chang'd its situation, in confequence of every change of fituat.on in the body •,
fo he would have fliown us from whence we might conjecture that the cyft
had but one cavity. It came into my mind, from whence this might be con-
je<ftur'd, as I have faid above (») : but we mult inquire ftill farther into that
fubject •, and into this moreover, how we may know, that the parietes of the
cyft are not vitiated with tumours, or abfcefTes. And he had thought it ne-
cefTary, in the firft place, that there fhould not be fo great a quantity of wa-
ter, as that the vifcera, being fore'd up very high, muft be liable to a very
great compreffion, betwixt the cyft, and the diaphragm : but it is furprizing
that this never had happen'd in the widow he fpeaks of. However, it is
'difficult to find women who are willing to fubmit to the operation of pa-
racentesis, before they are loaded with a great quantity of water : and, in-
deed, it generally happens that they do not fubmit to it, till their ftrength is
greatly impair'd, and their vifcera injur'd ; or, at leaft, affected with difeafe :
and then they cry out for any kind of affiftance whatever.
Yet there is, you will fay, an example of a woman (0), who, having, at
length, fuffer'd the water to be drawn off", when the cafe was fo far advane'd,
that " the fkin fcarcely adher'd to her bones," was perfectly cur'd by this
means ; notwithstanding on the firft, and the following days, bad figns ap-
pear'd ; except that a fiftula of the belly remain'd : cur'd, I fay, fo that me
conceiv'd, and brought forth children, and liv'd in a corpulent and flourifh-
ing ftate of health fome years ; till, at length, fhe was taken off" by an epi-
demical fever. I fhall not fay, here, that the woman was young : nor fhall
I fay that while fhe had a tumour of her belly, a very great difficulty of
breathing, a cough, and tumour of the feet, did not attend it. I fhall obierve
this one thing, that thefe figns are common both to the internal encyfted
dropfy, and the dropfy of the peritonaeum ; and that it does not certainly ap-
pear, from the hiftory, that the woman had labour'd under the one, rather
than the other-, efpecially as another woman •, who had been, likewife, fup-
pos'd to be afflicted with a dropfy of the tube, from the fame figns (/>), and
who, having been extremely well on the firft day from the drawing off" of the
water, was foon after attack'd with unkindly fymptoms, and died on the
feventh day from the difcharge of the water •, fhow'd that water, to thofe
who diffected the body, to have been collected betwixt the peritonaeum, and
the indurated omentum : and this is openly declar'd with a candour that de-
ferves every kind of commendation.
And, indeed, that, agreeably to the fame defire after truth, I may conceal
nothing from you, take this for granted : if any one contend that thefe two
cures of du Verney, related rather to the dropfy of the peritonaeum, I have
nothing to reply in objection to his opinion •, efpecially, as it was not in his
{») N. 64. in fin. (/>) Ibid. n. 7.
(0) Eph. n. c. cent. 9. obf. 100. n. 5.
4 power
Letter XXXVIII. Article 71. 36 r
power to examine by diffection, that virgin who was cur'd, and as the wi-
dow, whom perhaps he might have examin'd, he did not examine : and even
in the place where he firir related both thefe cures, there, as I have (aid above
(q), he has exprefly afferted, that he had leen none of them cur'd, who were
troubled with an internal encylled dropfy.
71. In the mean time, till others can teach more certain methods of cure,
I fhould fuppofe it would be better to imitate that cautious phyfician Tar-
gioni (r), and to be content to make ule of the palliative cure in the in-
ternal encylled dropfy •, which Schorkopffius (s) had, alfo, " principally" re-
commended. Targioni has many admonitions to this effect, which you may
ielect, and prudently follow-, not neglt&lng even this lalt, that when drop-
lies of that kind arc already large, thole poftures, motions, and exertions,
of body ought to be avoided, from whence the fcytt may prefs too much
upon the vilcera, or the vilcera upon the cyfl. For with how much eafe
cyfts, which are not very large, are fometimes ruptur'd, the hiftory that I
related to you above (l) fufficiently demonftrates. And a violent fit of
laughter, in that woman, did the fame thing which it had done in a man, of
whom Hoffmann (it) has left us an obfervation. For he very properly argues,
that from too violent laughing, the fac in the thorax, which had contain'd a
great quantity of water, was ruptur'd ; becaule the difficulty of breathing,
which had exifted before, together with a fix'd pain of the left fide, was
immediately chang'd into fuffocation : and as this carried the patient off in a
iliort time, in the left cavity of the thorax was found, not only a great quan-
tity of water, but in the fame place, alfo, many " lacerated membranes, and
" veficles, feparated from the vertebra?, and ribs, which pretty plainly fhow'd"
a rupture of a lac, and perhaps a Hidden effufion of very acrid water.
For it is not always lb eafy to discharge the extravafated water by the urinary
palTages, as it happened then in that woman : for in the man even time was
wanting. From whence you will, alfo, more eafily underftand, how greatly
they err, who ule the more violent remedies, againft dropfies of this kind in
particular ; I mean fuch as emetics, and purgatives. And, indeed, Wepfcr
(x\ having found, in a woman who had an afcites come on after an enor-
mous vomiting, the ovarium enlarg'd in its bulk, and lacerated to a furpriz-
ing degree, fuppos'd the water to have flow'd out from hence, into the ca-
vity of the belly. And you yourfelf will form the fame judgment of thofe
two women whom I have taken notice of (y) from Schacherus, and Gutter-
mann, as being found to have an afcites, at the fame time that there was a
rupture in the dropfical ovarium ; if, in reading over the hiftory of each wo-
man (2), you obferve what kind of medicines they had taken, and what ef-
fects they had fuffer'd from thence.
But while I am defirous of gratifying your wifhes, I have carried my dif-
cuurfe out to fuch a length, as I did not at all intend from the firft ; and that
almoft without perceiving it. I therefore make an end of writing at prefent.
Farewell.
(g) N. 68, (a) Med. rat. t. 4 p. 4. c. 14. obf. 7.
(») Cit. fupra ad n. 64. (*) Apud Scorkopfnum modo cit. th. 23.
^s) Thef. 25, fupra ad n. 69. cit. (y) N. 64.
{tj N. 69. («) Schacheri vid. §■ 16. in fin.
Vol, II. A a a LETTER
362 Book III. Of Difeafes of the Belly.
LETTER the THIRTY-NINTH,
In which the internal preternatural Tumours of the
Belly that remain are fpoken of.
AS I have treated fufficiently of the afcites, and other univerfal tumours
of the belly, in the preceding letter-, it now follows to fpeak of thole
which diftend fome particular parts thereof; fome of the upper and lower,
however, excepted : as the tumours, with which they are affected, are al-
ready written of in other letters (a). Valfalva then has left thefe five ob-
fervations, relative to thofe which occupy the middle and the lower parts of
the belly.
2. George Marchefi, a nobleman of Forli, who labour'd under a large in-
ternal tumour of the belly, had a pain in his back, and in his loins on the
left fide. His urine he difcharg'd frequently, but the inteftinal excrements
not without the greateft (trainings. He had an appetite for food. Yet all
the parts of the body being, at length, quite emaciated, and extenuated ;
except that the left fide of the fcrotum had been long affected with a hard
tuberofity ; and on the laft fifteen days of his life his feet having a very con-
fiderable cedematous tumour; his left foot was feiz'd with an eryfipelas, and
this noble youth died on the day following.
The belly being open'd, in its center a large bulk of tumour appear'd,
which fo compreis'd the vifcera every where, that if they were not forc'd
quite out of their natural fituation, they were, at lead, very much contracted,
and, in many places, of a livid hue •, although, in other refpects, as far as
could be perceiv'd by the eye, found. This tumour hung from the mefen-
tery •, being cover'd, on its whole anterior furface, with the omentum, which
was, extenuated, and in many places lacerated. The omentum being fepa-
rated, and taken away from thence, the figure of the tumour came fomewhat
better into view. This figure was very irregular: and, on the upper part,
two protuberances were extended towards the hypochondria, one on each
fide •, fo that one of them not only cover'd the liver, and the other the ipleen,
but thefe vifcera were even considerably forc'd upwards thereby. And the
ftomach itfelf was not quite free from prefiure •, being fomewhat confin'd by
the middle body of the tumour, from which the two protuberances were
fentoff. And the weight of the whole tumour leem'd to be about five and
twenty pounds.
(a) Epift. 36 & 38 ex parte.
4 But
Letter XXXIX. Article 3, 4. 363
But even in other parts, on the OUtfide of* the tumour, the whole mefen-
tery was turgid with the fame kind or' fubftance, whereof the tumour con-
fifted •, and with this tumour another tumour was alfo joirVd, of the lame na-
ture with that which was in the left tefticle. That is to lay, the nature of
both thole tumours was, in great meafure, fimilar to that of cancerous tu-
mours; and, in particular, of fome which are obferv'd in the breafts. The
bodies whereof they confifted, molt of them, approach*d to a glandular fub-
ftance, and refembled puff-balls in their figure, or as they are calPd in our
language tartujfi. They were of a different magnitude : fome of them were
whitifh like fat, but others red like flelh •, and many were even blackifli,
as if from concreted blood. In fome of the interftices of the body pus, bur
in others ichor, and in fome a yellow ferum, ftagnated. Yet in no part of
the tumours was there more ferum, than in that which was in the tefticle.
3. Wc have, now, all the circumftances that relate to this hiftory, a part
of which I have already produe'd (£), having promis'd the remainder, with the
obfervations of Vallalva ; fome feledt ones of which I then intended to pub-
lifh in the latter end of his differtations. And indeed this is not one of the
molt inconfiderable, if we attend to the extenfion, and weight, of the tu-
mour, at the fame time. For in regard to the former property, it does not
efcape me, that other large tumours of the mefentery have, fometimes, fo
extended themfelves, in their upper part, to the liver, or fpleen, as to have
made phyficians fuppofe, upon examining the abdomen of the patient, that
one, or other, of thefe vifcera, was converted into a fcirrhous mafs. But,
here, befides that it cover'd, with its upper appendages, both the liver, and
the fpleen, it produe'd its lower appendage downwards, in fo extraordinary
manner, as to join it with the tumour of the left tefticle.
You will read, indeed, the defcription of a fteatoma, by thofe celebrated
men Heber.ftreit (7), and Matthia (d), which being in the mefentery, had
drawn up one tefticle within the belly to itfelf, inftead of being extended down-
wards thereto •, and although, in the fecond obfervation, it was produe'd to
the femur, and furrounded the crural veffels, yet in neither did it afcend to
the liver and fpleen. But the weight of the tumour, in both of thefe obferva-
tions, and ftill more in that which will be taken notice of below (e)t was in-
deed greater than in that made by Vallalva. Yet who can deny that the tu-
mour defcrib'd by him, was one of the large ones that are found in the me-
fentery, even when we confider its weight? Since Wharton (f), who men-
tions many of them, gives account of no more than two confiderable tu-
mours ; one of which, having been obferv'd by him, weigh'd about feven
pounds, and the other that had been obferv'd by Parey, weigh'd ten pounds
and a half, though its fize is faid to be " wonderful, and almoft incre-
" dible."
4. As to the fymptoms remark'd in the living patient, you will certainly
not expect me to fay why, although he had an appetite for food, he became
emaciated in his whole body, if you confider by which way the chyle is to
be carried into the blood •, nor yet why the feet iwell'd to fuch a degree, if
(b) Epilt. anat. 2. n. 67. (<>) N. 8.
(c) Diifert. de part, coalef. mbrb. §. 17. ' (f) Adenogr. c. II.
(d) Commerc. litter, a. 1739. hebd. 48.
A a a 2 you
364 Book III. Of Difeafes of the Belly.
you confider through what parts the iliac veins, and the cava inferior, pafs.
Moreover, the weight, and bulk, of the tumour did not only prefs upon the
chyliferous, or fanguiferous velfels, but alfo the bladder, and inteftines. For
v/hich reafon, as the one could not eafily be diftended, and the other not eafily
dilated, the patient was under a neceflity of making water frequently, and of
difcharging his excrements with great {trainings.
The laft of thefe circumftances is (hewn, by Fernelius (g), to happen often
in this difeafe, and for the fame reafon •, and both of them, or, atleaft, acoftive-
nefs, and a difficulty in difcharging the urine, you will fee obferv'd by Parey,
and explain'd in the fame manner, in the cafe I took notice of juflnow (h)>
which is alfo transfer'd into the Sepulchretum (/'). In that cafe a pain is, at the
fame time, fpoken of, which, as in our cafe, was very troublefome in the back,
and the loins ■, and you know to which of the vertebra; the mefentery is con-
ceded. This pain, and difficulty of making water, are not wanting, like-
wife, in the next hiftory of Valfalva.
5. A woman of fixty years of age, having complain'd, for many months,
of a certain tumour in the umbilical region, began to be troubled with a
heavy and oppreflive pain, towards the back, which was fometimes attended
"with a difficulty in making water. The tumour was every day increas'd,
though it was already as large as the uterus in a pregnant woman can be ^
and, in conJequence thereof, the pain I have defcrib'd increas'd alfo : efpeci-
ally when the woman, being in a recumbent pofture, turn'd herfelf from
one fide to the other.
Upon opening the belly after death, a great bulk of tumour appear'd.
This tumour had its bafis in the center of the mefentery, and was connected
with the adipofe membrane of the right kidney •, butadher'd to the termina-
tion of the inteftinum colon, in fuch a manner, that they could not be divided
without laceration. The fubftance of the tumour was in fome places firm,
but in others foft, fo as to refemble a fteatomatous matter. The right kid-
ney abounded with particles of fand, and had its pelvis very much dilated*.
But the remaining vifcera were found.
6. Although it is not to be doubted, but that difficulty in making water,
and the pain which lay towards the back, related, in fome meafure, to the
kidney alfo ; as this had fandy concretions form'd in it, and could not but have
its proper membrane fomewhat pull'd away, at the fame time that its com-
mon, that is the adipofe, membrane fuffer'd diftraclion ; yet this diffraction,
was brought on by the weight of the annex'd tumour, and the frequent dif-
ficulty of making water, in the latter part of pregnancy, happens from
the bulk of the greatly-enlarg'd uterus, with which this bulk of tumour, as
I have faid, might have been compar'd : and if we fuppofe it to have been
more protuberant on the right fide, near to the kidney, as that connexion
feems to prove, it may from hence, alfo, be eafily underftood, how the dila-
tation of the pelvis had been brought on ■, that is, by the ureter being fre-
quently compreis'd, and the defcent of the urine being obltructed.
But be this as it will, you will, perhaps, befurpriz'd at one thing, in both
of thefe hiflories, which I have given you ; I mean, that befides the pain in
(g) Pathol. 1. 6. c. 7. (/) Sett, hac 21. obf. 38.
(6) N. 3.
the
Letter XXXXIX. Article 7.
365
the loins and back, which was a necefiary confc-quence from the weight of
the diffracting tumour, no particular pain is fpokcn of, that bclong'd imme-
diately to the tumour itfclfj or, at leaft, to thofe membranes of the mefentery;
betwixt which it lay. But you will ceafe to wonder, when I (hall have mown
that the obfervations, and writings, both of the ancients, and moderns, agree
with the hiftories of Valialva. Under the name of ancients, I do not under-
stand here, any more ancient than Benivenius, who flouri(h*d about the be-
ginning of the fixteenth century. Yet I do not think that theft difeafes of
the mefentery were unknown to thole who wrote long before his time. For
although they were not accuftom'd to diflec~t human bodies, yet they fre-
quently usrd to diflecl the bodies of brute animals, in fome of which ic can-
not be fuppos'd but they muft have met with this appearance, that I even
met with in a little hen-chicken.
This chicken was greatly emaciated, and greatly voracious-, yet her belly,
was equally tumid, as if fhe was about to lay an egg, which as yet (he.
was too young to do. This tumour was ma'.'.e up of roundifh and fcirrhous
bodies, many of the fize of a bean, and fome of the bignels of a chefnut, lying
betwixt the folds of the inteftines, and fome of them even fix'd thereto ; all
of them of a granulated furface, and even granulated in their ftruclure ; ex-
cept that one of the largeft contain'd a great fubftance, every where fur-
rounded by thole very hard granules, and refembling a white, and tender, but
juicelefs, and almoft friable fuet : fuch as, in the preceding letter (k), I de-
fcrib'd in the uterus, and the ovaria, of a certain woman. But here the ovarium
was found, together with its very fmall eggs, as both of the pancreas were; andr
if you except the increas'd magnitude, the liver alio, and fpleen, and indeed*,
the inteftines themfelves, were found.
It therefore does not feem probable to me, that no tumour had ever been
obferv'd in the mefentery, by cooks, by butchers, by thofe who facrifte'd beafts^,
and fhown to phyficians ; fince Galen, as I have taken notice to you alrea-
dy (I), had feen a fcirrhous tumour round the heart, in a cock, and transfer'd.
the difeafe to human bodies. I fhould rather fuppofe, that what the ancient
phyficians might have hinted, in regard to this fubjedr, had been loft by-
length of time, as fo many other things have. For if Julius Pollux, as I
have read in Ingraflia (»;), " afTerted, that ftrumous tumours are form'd.
" even about the mefentery," certainly either the grammarian himfelf took
the hint from fome phyfician •, or, if it happen'd that he faw it himfelf, it is
difficult to fuppofe that the phyficians who wrote from the latter end of the
fecond century, to the beginning of the fixteenth (for they fay that Pollux,
as well as Galen, liv'd in the reign of the emperor Comrnodus) being admo-
nifh'd by a grammarian, mould none of them have faid a word about disor-
ders of the mefentery of this kind.
7. Benivenius (») then found " a callus" (by which I underftand a hard:
tumour) among the mefenteric veins of a boy, that obftrudted thofe veins by
its prefTure. And Ingraffias (o) found, in the mefentery of a black, who
was publicly hanged, about feventy ftrumas, beftdes almoft as many tumours,
<■*) N. 34.
(I) Epift. 16. 11. 20.
{m) De tumor, tr. i. c. 1. comm. 2,
(») De abdit. morb. cauf. &c. c 37.
\c) Comm. cit.
adhering
366
Book III. Of Difeafes of the Belly.
adhereing to the external coat of the inteftines •, in both which kinds of tu-
mours •, though fome were of the fmallnefs of a vetch, others of a hen's egg,
'and many of a middle fize betwixt thefe two •, was univeriatty contain'd c itlier a
liquid, and a mucous matter, or a gypfeous, and ftony matter. Yet Benive-
nius, when he mentions the other disorders of the boy, fays not a word of
pain. And all who knew the black of Ingrafilas, have, with a common, and
full cohfent, averted, " that he had been extremely healthy, till he was
M hang'd," which is a circumftance really furprizing.
Nor, indeed, do I believe that Fernelius (/>), when he, in general, afTerted,
that a tumour of the mefentery " gave no pain," had laid it without having
made fome obfervations, from whence to make fuch a conclufion ; notwith-
itanding he immediately adds this reafon for his afiertion, " that the part it-
" felf is incapable of pain." And this I believe dill more of Arantius (q) ; as
he feems to have obferv'd tumours, in that part, lb large, as " fometimes to
" exceed the fize of a pine-nut, and the head of a child :" and he certainly
gives the figns of it in fuch a manner, as to feem to have had before his eyes
a ftructure fimilar to that which is defcrib'd by Valfalva (V), in Marchefi. For
it is, fays he, " a tuberous and unequal tumour, by reaibn of its being made
" up of many glandular bodies, connected together ; which being furpri-
" zingly increas'd in their magnitude, cohere with each other, and form un-
V equal tumours, refembling mufh rooms, and llich-like vegetations.
But he gives this as the firft fign of all, " that the tumour is indolent." Per-
haps you will here fay, that hard and cold tumours, as they call'd them, were
obferv'd by Benivenius, and Ingraffias j and that Fernelius, and Arantius,
certainly did not intend to refer to any other. But certainly Benivenius (j),
when he found a tumour of a different kind, which had already degenerated
into a large abfeefs of the mefentery, remark'd that there had been tormina of
the belly, which increas'd every day, and, being grown intolerable, kill'd
the patient. And I do not doubt, but you have likewife read, even in the
Sepulchretum, that colic pains, or pains fimilar thereto, have been obferv'd
to be the confequents of abfceiTes, and apoftems, in the mefentery ; according
to the teftimony of Mermannus (/), Folius (u), VVepfer (x), and Senner-
tus (y).
It does not, however, efcape me, that thefe objections may be made: part of
which did not efcape Marcellus Donatus (z), who I fee had read molt of
thofe things, that I have hitherto laid, of tumours of the mefentery, whereof
mention was made in books, even in his time. And as he openly contended,
as much as any one, that the mefentery was affected with no pain worth
ipeaking of •, becaufe, among its conftituent parts, he acknowledg'd none to
be endow'd with fenfation, befides the nerves, and the membranes; the fenfe
of which parts he did nor, however, doubt, was made very dull and ob-
tufe, by the great quantity of fat that lay round them ; he judg'd that the
pain remark'd by Benivenius, was not a pain of the mefentery, but of the
inteftines. That is to fay, he fuppos'd the pain to have been excited in that
(/>) C. fupra ad n. 4. cit.
(g) L, rie tumor, p. n. c. 44.
(/•) Supra n. 2.
(s) L. cit. c. 33.
(/) («) (a) (J) L. 3. f. 14. obf. 30. §. 10.
& §. 13. & feq.
(z) De med. hill, mirab. 1. 4. c. 7.
tract
Letter XXXXIX. Article 8.
367
tract of the inteftines, in particular, wherewith the difeas'd portion of" the
meientery was join'd, by the weight of a great quantity * t matter, which
created the abfcefles, either comprefling, or dragging it downwards ; to lay
nothing; of the acrid exhalation of this matter.
8. Though it is by no means incumbent upon me, to approve of every tiling
that Marcel 1 us, as I have laid, fuppos'd •, yet it does not feem poffibleto deny
this, that alvi tormina ; for thefe are the words us'd by Benivcnius j fignify
pains of the inteftines, rather than pains of the mefentery : or, if this fhould
be doubtful to any one, becaufe thefe words are prelently added, " all the
" vifcera appear'd to be found, the liver, fpleen, and all the inteftines, fhowing
" no mark of pain •," it is certain, that in other hiftories, at lead, which 1
have taken notice of, " a coke," or " pains, like to colic pains," are ex-
prefsly mention'd. And left you mould imagine that thefe only happen
when there is an abfeefs, read Platerus (a), and Wharton (l>), who oblcrv'd
" colic pains," in thofe perlbns, in whole meientery the former found " hard
" and glandular tumours," fo grown into one fubftance with the inteftines,
that, by ftreightning their canal, they hinder'd the defcent of the excre-
ments ; and the latter, a fingle tumour, but fo large as to thruft the inteftines
to one fide : and that " a glandular, and fiefhy, more than an humoral, tu-
M mour."
But if in the obfervations of Valfalva (c), and others, that I have quoted above
(J), thefe pains are not laid to have been brought on, by tumours of this kind,
it is to be fuppos'd, that in fome the inteftines were not equally comprefs'd ;
and in others, that they had not an equal quantity of feces, or that the feces
were not equally acrid: which firft circumftance you will particularly fuppofe
of the woman, whole mefentery, as you will fee in Coiterus (V), was " made
" up of many, and thofe pretty large, fcirrhi ;** but me could fcarcely fwal-
low any thing, even that was liquid. So you will fay that there were fome
other caufes, if not the fame, even in particular abfcefles of the liver; for
we do not read of them all being attended with pains. Excruciating tor-
tures are indeed taken notice of by the fame author (f), in- the defenption
of a large abfeefs ; but they were fuch as may be refer'd to the difficulty of
making water, and the other inconveniences that are related : fince not the
leaft mention is made of pains of the belly, or inteftines. And, indeed, Do-
natus (g) gives an obfervation made by him, of a large abfeefs j as a great
quantity of bloody and purulent matter, which was dilcharg'd by (tool, and a
fordid ulcer of the length of a fpan, which remain'd in the mefentery, de-
monftrated : whereas, in a very long ficknels, no complaint was ever heard
of pain, unlefs on the laft day of her life, and difeafe.
But much more furprizihg than others is the hiftory of Hearnius, which you
have in this twenty-firft fection of the Sepulchretum (b). For in this hiftory,
though other fymptoms are defcrib'd, there is not a word of pain in the belly:
Which circumftance is not fo furprizing, on account of twelve, or more pints,
of fluid matter, that was in the triple tumour, as on account of the weight-
(a) Sepulch. obf. 30. cit. §. 11.
(b) Adenogr. c. n.
(0 N. 2. &5.
(d) N. 7.
(?) Obf. an at.
(r) Ibid.
(g.) C. 7. paulo ante cit.
.(/,) Obf. 56. §. 1.
of
368 Book III. Of Difeafes of the Belly.
of the whole tumour, which was equal to fifty Swedifli pounds ; and its firu-
ation, which was almoft the whole ipace of the mefentery. To this may be
added, that the tumour was cloiely connected to the inteftines, from the duo-
denum to the middle of the ileum, as if it had coalefc'd into one fubftance
with them, lb that it could not be feparated without rupture •, and that the
quantity of food which was taken in, was fcarcely fufficient to fatisfy the de-
fire of the patient-, as his appetite was continual, and almoft canine : fo that
we are not at liberty, here, to fuppofe either a fmall quantity of excrements,
or that the inteftines were not comprefs'd •, but a far different reafon muft be
thought of by any one who would endeavour to account for the abfence of
pains, which I fhall endeavour to do below (/'). For at prefent, it is necef-
lary to point out other obfervations, in which thefe pains were not abfent, that
you may add them to the Sepulchretum.
There is one of Dolseus (&), wherein a tumour, fomething lefs than that
defcrib'd by Valfalva (/), but of a ftruclure not unlike it, was attended with
dreadful tenfions, and a troublefome fenfation, as if living whelps were nou-
rifh'd in the belly •, but the tumour arofe from the mefentery : however, " it
" was fix'd to the fmall inteftines, in feveral places : and the inteftines even
" pafs'd through its fubtlance." The fecond obfervation is that of Verdrie-
fius (in), who defcribes the whole mefentery as being " fteatomatous," after
tormina of the belly, and not without a large abfeefs •, but, at the fame time,
defcribes the inteftines as " cohering clofely to one another." The third ob-
fervation is that of Laubius («) on a man, who, being afflidted with very
troublefome pains of the belly, had tubercles in the mefentery indeed j but
his inteftines were alfo fill'd with a great number of " fteatomatous" abfeeffes
•of the fame kind. On the contrary Goekelius (o) remark'd the whole me-
fentery, in a moft noble count, to be befet with a great quantity of fcirrhous
and febaceous fat •, and yet " there had been no tormina."
To conclude therefore ; in the obfervations produe'd both by the ancients,
and moderns, either pain is not faid to be join'd with a tumour of the me-
fentery ; or if we do read of it as join'd therewith, it does not appear to have
been in the mefentery itfelf, rather than in the inteftines. And much lefs
does it appear in the hiftory of Jo. Scultetus, which is extant, likewife, in
the Sepulchretum (p); for it does net fufficiently appear, that the excruciat-
ing pains of the belly were on the outfide of the inteftines : and if it did ap-
pear ; as the very acrid matter, which was contain'd in the fix tumours of
the mefentery, is faid to have corroded, to a great degree, all the vertebras of
the loins •, thofe who attended to the other obfervations, would not be at a
lofs to conjecture a different feat of the pains, or of the origin of pains, on
the outfide of the mefentery : as they certainly would not, in that example
which follows :
9. A woman, of eight and twenty years of age, had been troubled, for the
ipace of four years, with pains of her belly, which were fometimes attended
with a flight fever : at length, being grown more violent, they carried her off.
(;) N. u. («) Eorund. torn. 2. obf. 108 partic. 2.
(JtJ Eph. n. c. dec. 5. a. 5 & 6. obf. 258. (-») Eph. n. c. cent. 6. obf. 94.
(/) N. 2. (t) L. 3. f. 14. obf. 30. $.12.
{m) Att. n. c. torn, 1. obf. 87.
The
Letter XXXIX. Article 10, u. 369
The abdomen of the carcafedid not appear to have any of that externa]
tendon, which had been about the umbilical region, in the living body.
Yet in the center of the mefentery were two tumours. One of which, be-
ing of the bignefs of a goofe's egg, lay towards the right kidney, and was
internally ulcerated ; yet without containing any thing purulent : but the
other was much larger. For it was continu'd to the right kidney, infinuat-
ing itfelf, ill fuch a manner, betwixt the internal, and external, coat thereof,
as to cover the whole kidney, and could not be pull'd away from it without
the greateft difficulty ; and it extended itfelf quite to the os pubis of the tame
fide, being equal in thicknefs, in fome places, to two fingers, and, in others,
to three. This tumour at firft fight reiembled coagulated blood. But the
whole of it was inveited with firm membranes, that were given off* from the
peritonaeum: and it confided, in many places, of a lubdance extremely fimi-
lar to flefhy fibres, except that they were here ting'd with a black colour, and,
in fome places, were lb lax, that they feem'd to be nothing more than con-
creted blood.
10. If I were certain that Valfalva perform'd this difioftion while he was
as yet a very young man, as I fufpedt he did, I fhould certainly believe that
fome aneurifm was delcrib'd in this fecond tumour. But although it was no-
thing more than what it then feem'd to him, to be •, that is, one of thole tu-
mours of the mefentery, of which the quedion is here ; it certainly could
not extend itfelf quite to the pubes, and to the right kidney, lb as to cover it,
without forcing, and comprelTing, the inteftines; nor infinuate itfelf betwixt the
coats of that kidney, and affix itfelf fo clofely to the proper membrane of thefe
two coats, and the kidney itfelf, without creating long and grievous uneafi-
nefies ; although they have their origin in that part, yet very often extend
themfelves to the interlines, and very often feem to be pains of the interlines,
rather than of the kidney, as you are by no means ignorant. In the mean
while, I would not have you believe it to be my opinion, that there can be
no tumour of the mefentery, which is itfelf the feat of pain: I only would
have you underdand all the remarks that I have hitherto made, and produe'd,
in fuch a manner as to perceive, that there is none of all thefe oblervations,
from whence it plainly appears that the pain was in the tumour itfelf.
11. And this is really furprizing ; whether you confider the quantity of
nerves in the mefentery, or the office of its glands. For in the breads is a
far lefs number of nerves in proportion : fo that if the glandular tumours of
thefe parts brought on the mod excruciating pain for this reafon, becaufe
M the crude chyle being apt to contradl an acrimony, or fharpnefs, cannot be
" fent into other parts in fo crude a date, and in fo great a quantity ," as in-
to the breads ; there would certainly be a more fevere pain in the tumours
ot the mefentery (the glands whereof the learned gentleman does not feem
to have attended to, when he wrote thefe things) as into this part the whole
of the chyle flows •, and, what is more, in a dill cruder date. You would
fay that in the mefentery it is diluted with the lymph, and that it goes on
therein, in order to arrive at a farther dage, indead of dagnating, as it does
in the bread ; unlefs the incipient tumour itfelf fhould caufe a remora, both
to the lymph, and to the chyle, and foon after differ the lymph, as the thin-
ner fluid, to flip by, and retain the chyle.
Vol. II. B b b Docs
370 Book III. Of Difeafes of the Belly.
Does the pain, then, which is actually feated in the mefentery, feem to be
in the inteftines, the nerves that go thither being prick'd, juft as happens in
the foot which is already amputated ? Is there not a humour in all tumours
or" the mefentery, which may thus prick the nerves ? Or is" there a humous
in fome which may blunt the fenfation of the nerves by relaxing them ? Or
are the nerves, in conlequence of their being intercepted by the hardnefs of
thefe tumours, fometimes made incapable of the office of fenfation, juft as
they would be by having a ligature made upon them ? But if we iuppofe
this, you will not be able to conceive afterwards, how it happen'd that Lau-
bius (q) remark'd " tormina, about the navel," when " a hard and compact
" fteatomatous abfeefs, which exceeded the fize of a man's fift, was feated in
" the pofterior part of the mefentery, where it is connected to the lumbar
" vertebrae, furrounding the larger veffels of that part."
For, according to this hypothefis, it feems that the nerves lying upon thefe
veffels, and going to the mefentery, and inteftines, muft have been intercept-
ed, and comprefs'd. See then that you think of fome other hypothefis to
add thereto, and confider of the other explanations, which I juft now hinted
at, and accommodate the other hypothefis to other obfervations. None of
which, or at leaft none of thole that we have attended to, you can fuppofe
explicable by you, in the manner Bierlingius (r) has hinted •, as he thought
M that through fo many ages, fo many authors were deceiv'd ;" if not always,
vet " many times ;" while being ignorant of the real ufe of that large gland
in the center of the mefentery, and of the receptaculum chyli, they had, af-
ter death, from this which was even then full of chyle when cut afunder,
" generally made an abfeefs of the mefentery :" as if either the abfeeffes
which molt authors have given the relation of, were not defcrib'd to be full
of a fluid quite different from chyle •, or as if that large gland was the fame
in the human body, as it is in that of the quadruped fpecies.
I omit the different fituation of fome abfeeffes and tumours, and the num-
ber, or the magnitude, of the greater part of them which have been obferv'd,
even in the living body. Nor fhall I deny what the celebrated Haller (s)
thinks ; I mean that the mefenteric glands, " which are fometimes very large
M indeed, in younger animals (but agreeably to the receiv'd law of nature
" in conglobated glands) have been taken for difeas'd glands, when they
" were very found." But when there are either many more than this law
requires, or they are harder than is natural, there certainly is no room for this
iufpicion •, as, for inftance, in that diffecfion of the boy which I have quoted
(t) from Benivenius. For he would not have call'd the tumour " a callus •/'
nor have faid that " all " the meferaic veins were obftrudted thereby, if he had
not found a tumour amongft thofe veins, which was not only large, but
very hard.
However, in regard to the hardnefs, both the different nature, and the
different age, is to be confider'd in thefe tumours. And how often their na-
ture approaches to that of a fteatoma, you might have obferv'd from riioft of
the obfervations which have been produe'd. And yet it is very different at
(g) Aft. n. c. torn. 2. obf. 108. (;) Not. 2. ad §. 12S. prslecl. Boerhaav. in
(Y) Eph. n. c. dec. 1. a. 2. obf. 152. inllit.
(t) N. 7.
dif-
Letter XXXIX". Article 12. 371
different times. Sec, for inllance, thofe medical themes of that excellent
anatomiil Solomon Alberti, which are publifhM, together with his three
orations, and relate to the difeafes of the melentery, and pancreas. You will
find many things therein, by which fome of the remarks I have mule above
are conlirm'd ; but the following words in particular: that the humours
putrefying in. the mefentery, " fometimes raife it up into a tumour, which is
" at liril lax and (bftj but in procefs of time, the humours gradu illy drying
" away, becomes to hard; and gives fo much refillance to the touch, that in
" the parts about the navel, and the lower part of the belly, you would think
" either a bone or a calculus had been form'd." But, pn the, other hand, it
happens, at different times, that thole parts which were hard grow (oft by
putrefaction. And to this clais, among others, belongs that oblervation alio
of Andreas Veltphalus (xj, who having found in the belly of a woman, but
principally about the navel, " many hard tumours, which at length grew
" (oft again in a courfe of time," law in her body, after death, the mesen-
teric glands " for the moft part ulcerated, but fome ftill indurated."
Now, however, let us fee about thofe tumours that belong to the lower
part of the belly.
12. A woman, of forty years of age, began formerly, after the abortion
of a foetus of almoft five months old, to oblerve a certain hardnefs about the
uterus, and to be attack'd with a pricking pain, in the fame part, which was
flight indeed, but continual. Sometimes {he was feverifh. The tumour,
in the mean while, increas'd outwardly •, yet in fucli a manner as to be move-
able : for it was fometimes perceiv'd in the middle, and fometimes at the
fides. She had a confiderable pain in her head : (he went to ftool with great
difficulty : a vomiting was at times troublelbme : and the pain in the tu-
mour was, at certain times, fo excruciating, and particularly when it was in-
creas'd by uneafinefs of mind, as to excite an ardent fever, and to be almoif
intolerable. Thefe circumftances which I have mention'd happen'd within
ten years : in which time fhe never conceiv'd. Finally, the tumour being
become immoveable, and the pain, and the acute fever, being very violent,
{he was no longer number' d with the living.
The belly being open'd, a very great bulk of tumour was found by Val-
falva, fo as to be equal to the fize of a very large human head. This tumour
was feated in the pofterior paries of the uterus, vehemently comprefling the
inteftinum reel: urn, and being clofely connected to the furrounding parts. Ex-
ternally, indeed, it feem'd of a flefhy colour; but in its fubftance it was
more firm than flefli : and within this fubftance contain'd two finous cavities,
the parietes of which refembled putrid flefli. One of thefe cavities was
empty; but in the other was contain'd a ferous matter. This tumour alfo
occupied the feat of the ovaries. For which reafon no traces of thefe parts
remain'd : except that at the fides of the tumour were feen veficles turgid
with ferum ; fome of which were equal, in their magnitude, to that of a pi-
geon's egg. Part of the ferum collected therefrom was put on the fire, and
part of it mix'd with acid juices. Yet neither of thefe portions did in the lead
coagulate.
(u) N. 4 8c 7. (x) Diflert, de parte inteft. jejuni & ccet. c.
1 3- f • 60. .
B b b 2 13. This
372 Book III. Of Difeafes of the Belly.
13. This cafe needs no explanation : fo exaflly do the appearances, found
in the dead body, anfwer to what had been obierv'd in the living. That is
to fay, the hardnefs coming on after abortion, the pain, the tumour when
at length grown manifeft, the feat thereof, and the defect of conception for
the fpace of ten years, though in a flourifhing time of life, fufficiently argued
a tumour of the uterus : nor did the pain of the head, the vomitings, and
the violent increafe of pain in the tumid part, and particularly from the mind
being difagreeably affected, argue differently from the preceding fymptoms :
but the feverity of the tortures, and the fevers, demonftrated the malignant
nature of the tumour •, as the difficulty of going to ftool, rather than making
water, did alfo demonflrate to which part of the uterus it chiefly adher'd.
There was one thing, which, if you attend to Arantius (y), may not feem
to be very compatible therewith. For this author, in fpeaking of the marks
whereby we may diftinguifh tumours of the uterus from thofe of the mefen-
tery, fays, that thofe of the uterus " are painful, equal, endow'd with an
" oval form •, and are not entirely mov'd from their places." Yet the tu-
mour in our cafe was moveable for a long time •, and would, perhaps, have
continued fo for a very long time, nay perhaps always, if it had not at length
fix'd itfelf to the neighbouring parts very clofely. Had Arantius, therefore,
lit only on fuch tumours of the uterus, that were already become very large,
and connected to the parts about ? Or has he made ufe of words, which feem
to fignify that thefe tumours are more immoveable than he meant to affert ?
Ee this as it will, it was much more eafy in the preceding hiftory, than in
that which follows next, to conceive, before diffeetion, in what part the tu-
mour of the lower belly oonfifted: nor did this efcape the fagacity of Val-
falva, as you will immediately learn.
r4. A {lender woman, of about forty years of age, being much fubject to
the hyflerical paffion, and particularly to violent paroxyfms thereof, which
ihook her whole body, but principally the viicera of the belly, with convulfive
motions ; and having, at length, undergone fome that were more violent than
the reft, began to obferve a manifeft kind of deprefnon in the epigaftric re-
gion, and a manifeft fulnefs in the hypogaftric region. The former was
never chang'd ; but the latter frequently within the fpace of one day. For
although it fhow'd a pretty large and very hard tumour, yet this very often
fubfided of a fudden. In like manner, when aliment was taken in, the wo-
man perceiv'd it to be carried down quite to this tumour; that part being
from thence more elevated : and the fenfe of weight, which was always in
that place, became more burdenfome : and four or five hours after, very
ievere pains, tormina, and fwoonings, were brought on. The patient often
complain'd that all her entrails •, for this was her very expreflion •, were fallen
down from their fituations. Her digeftion was manifeftly deprav'd : (he was
ieverifh : and very much emaciated. Having liv'd in the manner I have de-
fcrib'd for three months, fhe died.
In the carcafe was found what Valfalva had predicted in his opinion ; thai
is, the ftomach fallen down to the hypogaftrium •, fo that fcarcely four fingers
breadth lay betwixt this viicus and the pubes. But it had a different pofitoa
(_y) C. 44. fupraad n. 7. cit.
r from
Letter XXXIX. Article 15. 373
from that, which the editors of the Bibliotbeca Anatomica (z) havcrcprckntcd,
from a certain virgin. For the part of the ftomach which corresponds to the
gula, was here extended, in length, to fucha degree, that the whole of the
fundus lay in the hypogaftrium.
15. This diagnofis of Vallalva was indeed very extraordinary, and the ob-
fervation no lels rare. To begin with the latter ; I would have you ob-
ferve that the ftate of the ftomach, in the hypogaftrium, may be very diffe-
rent. For iometimes it is fo very large, that in a woman whom I diffedted,
in the hofpital, about the middle of December in the year 1717, I law the
fundus of the ftomach to be no farther diftant from the os pubis, than in
the woman in queftion ; and demonftrated it to thole who were prefent : to
whom it feem'd fo much the more furprizing, on account of its being empty.
For that it may defcend fo far when it is immoderately diftended, either with
flatus, or included humours, that women may be fuppos'd to be far advane'd
in their pregnancy, or to labour under an afcites, is known from the obfer-
vations of Moinichenius (a) in particular, and Jodonius (b) ; the latter of
whom faw the ftomach, " when cut through the middle, to be longer than a
M Parifian ell ■" and the former, in this very theatre of our college, law " the
M whole abdominal region occupied, and the inteftines cover'd, therewith.'*
And to what a degree the celebrated Widmannus (c) found it extended, in
a man who us'd to fill himfelf every day with an almoft incredible quantity
of bread, and beer, the defcription of it ftiows.
But the ftomach lbmetimes occupies the hypogaftrium alfo with fome pare
of its bulk, as it does other regions of the belly •, not on account of its mag-
nitude being increas'd ; but, having its ufual and proper fize, either at
one extremity, for inftance the right, as in the example already refer'd to
(J) in the Bibliotheca Anatomica ; to which you may add another of Mery (e) ;
or in the whole of it, falls downwards. And it may fall down to the lower
parts of the belly, either in confequence of being drag'd downwards, or fore'd
from above.
In the patient of Vefalius (f), it was drawn " downwards from its fitua-
" tion, in fuch a manner," that the very function of the ftomach was deficient ;
and a fingultus coming on, death was the confequence thereof. It has alfo
been drawn down, by almoft all the inteftines having fallen into the fcrotum j
as in that observation of Mery •, or into a very long fac, as in another
obfervation made by the celebrated Henry Papen (g). And it has been
driven downwards in other bodies difiedted by Valialva fb), or by me
(i), by the diaphragm forcing it from above ; or being deprefs'd : or by the
liver being greatly increas'd in its fize -, of which laft kind, in particular, are
two oblervations of Fantonus the father (k) : and I take notice of all thefe
examples here, that I may, in general, point out the caufes of the depreffion j
and not becaufe the ftomach was really thruft down quite into the hypoga-
ftrium.
fzj Part. 1. ad Gliflbn. tratt. de ventric. Sc (f) Decorp. hum. fabr. 1. 5. c. 4.
inteft. c. 2. (g) Epift. de hern, dorfal.
(a) [&) Sepukhr. feft. hac. 21. obf. 42. & 48. (b) Epift. 17. n. 25..
(c) Ad. n. c. torn. 6. obf. 149. (:) Ep. 21. n. 24.
{d) N. 14. in fin. (*) Obf. med. anat. 5. & 24.
(e) Mem. de l'Acad. R. des fc. a. 170K
obf. 5.
la
374 Book HI. Of ^1C Dileafes of the Belly.
In the hypogaftrium, however, it was fecn by Ruyfch (7J, when he dif-
fered the body of a woman who had died of an afthma. But neither is the
caufe fhown, why " this vifcus, together with the inteftines, left its natural
" fituation, and occupied the hypogaftrium ;'! nor what inconveniences had
been the confequences of this unuiual fituation, in the living body : for
which reafons 1 purpofely omit other oblervations of its defcent"; efpeciaily
when in a lefs degree. But thofe things which have been lately obferv'd by
that celebrated man Molinelli (J»)i related rather, as I fuppoie, to another
diforder that wasjoin'd therewith-, I mean to a very large and hard tumour
intirely fhutting up the beginning of the inteftinum duodenum-, from whence,
not only the very difficult and long-continued vomiting of all the ingefta,
the very great wafting, and the icteric colour, may be accounted for, but
alio that "very great magnitude of the ftomach, which deli en led quite
" to the region of the pubes, and occupied almoft the whole hypoga-
" ftrium ;*' as the preternatural increafe of length in the cefophagus, and,
confequently, the prolapfus ventriculi, may be like wife. For as the annex'd
pylorus was more deprefs'd, on account of the weight of that tumour, fo
by reafon of the paflage, from thence to the inteftines, being fhut up, the
the feveral ingefta had not only enlarg'd the ftomach, by being confin'd
there for a long time ; but, finally, by frequently irritating them, and by
torcing them into violent contractions, which the very difficult vomiting was
a proof of, had drawn down the cefophagus, that is connected with the other
or:fice, and made it longer: fo that in this cafe a prolapfus of the ftomach
was added to its increafe of fize : and that not from cauies which fore'd it
downwards from above, but drew it downwards from below.
Nov/ if the obfervation of Valfalva be compar'd with all thefe, it will ap-
pear of how extraordinary a nature it is.
1 6. Valfalva then did not find a part of the ftomach (either on account of
its magnitude being increas'd, or of the fituation of one extremity being
chang'd) but the whole fundus, in the hypogaftrium, and not in the umbili-
cal region. The convulfions of the vifcera, that are contain'd in the belly,
had drawn this vifcus down in fo violent a degree, by extenuating that part
which is continued into the gula, and by this means rendering it longer. For
akhough Molinelli (;/) favv the gula itfelf become longer-, and Fantonus the
father, in the firft of the two oblervations (o) which I have fpoken of, has
remark'd that frequent complaints were made by the patient, of the tongue
feeming to be drawn back towards its bafis -, which was no inconfiderable argu-
ment, as the very learned fon has interpreted it (/>), of the cefophagus being
drawn, and extended downwards -, (nor, indeed, is it to be denied that fome
part of the great length which Valfalva faw, was a confequence of the cefo-
phagus being carried downwards) yet as he himfelf has acknowledg'd, that
it was the ftomach chiefly which was diftended, it does not become me to deny,
that the length is chiefly to be attributed thereto.
And if the obfervation of Vallalva were not very fingular, among others,
(/) Obf. anat. chir. 56. (//) N. 15. in fin.
(?/;) Comment, de Bonor.. fc. acad. torn. 2. (0) Obf. 5.
p. 1. in medic. (/>) Schol. ad eand. obf.
n on
Letter XXXIX. Article 17. 371;
011 account of thefc peculiarities which I juft now obferv'd, ic certainly would
be fo, on account or this difference; I mean, that although in the other ob-
servations, fome of the remaining parts of the belly were much affected with
difeafe, at the fame time, as the omentum, the liver, one of the kkJnies, the
pancreas, the duodenum, or fome other inteltine •, and not to omil other in-
juries of the ftomach itlelf, either the pylorus almoft obftru&ed, or ail the
parietes greatly relax'd ; in the obfervation of Valfalva was nothing of this
kind: but taking away that production of the upper part of the ftomach,
whatever dilbrder there was, confided in the prolapfus of this villus: lb that
it feems to have 1 een made in order to learn the peculiar figns of this dilbr-
der •, which are in fact fo expats and clear therein, that the difficulty, which
I have alferted to be greater in diltinguifhing this tumour, than that of the
uterus, (q), is not to be cftimated from the obfcuie fignirication of the figns,
but from the rarenefs of the dilbrder refer'd to.
However, even the rarenefs of the difeafe, itfelf, is not fufficient to baffle
the fagacity of thofe who know how to inquire fkilfully into the fymptoms,
and confider them duly, that is to fay, in other words, the fagacity of a
man " practis'd in diffections," as Valfalva was, " and in finding out the
II operations and ufes," of the internal parts: which two circumllances
Galen (r) ablolutely infifted upon as indifpenfable, in thofe phyficians who
" defir'd to obtain the capacity of diltinguifhing difeafes of this kind from
" one another •," after having fhown in what manner he himfelf had found
out the ftomach of a certain man to be fmall and round ; and the bladder of
another to be fmall and prominent ; and other things which were flill more
obfeure than thefe.
17. The fame author had taught, a little before (j), " that all things
" which are within the body cannot be certainly known'Y' and (7) that thofe
which do not fall under the notice of the fenles, " we muft endeavour to at-
" tain to by the molt artful conjecture, if not by the moft certain fcience :"
and having; faid all thefe things that 1 have related, of thofe internal confti-
tutions that are deriv'd from nature ; he has prefently after fhown (it) that
fiich ftates of thefe parts, as are the effects of difeafe, are to be diftinguifh'd
" from their operations being injur'd, or deprav'd •, or from the various ex-
" cretions ; or from pains, or preternatural tumours •, or from fome or all of
thefe united." And learnedly, as it became fo great a mafter, has he, in
this manner, fhown us the feats, and, as it were, the fources of difeafes.
But there is often fuch a complication of diforders, fuch a confent and vi-
cinity of parts, that this " molt certain fcience," of which he fpeaks, is rarely
to be expected : more generally " an artful conjecture " mult be attempted,
and modeftly and diffidently propos'd. And as I have been wont to do this
upon other occaiior.s, fo I thought it behov'd me to do it in fome cafes,
which are not very commonly known ; and which will be in the number of
thofe that I fhall now fubjoin, in fuch an order, that if they do not correfpond
with thole which I have given you from Valfalva, in the nature and feat of
the tumours, they may, at leaft, correfpond with them in the tumours hav-
(-) N. 13. in fin. (/) C. 72.
(») Art med. c. 74.. («) C. 75.
WC71.
ing
S76 Book III. Of the Difeafes of the Belly.
ing occupied the middle, dr lower region of the belly : although that tumour,
with which I fhall begin, was in part fix'd to a higher fituation, and did not
much differ in its nature from one of thofe (x) that are defcrib'd above, if
we do but allow of an aneurifm in that obfervation, and this of mine; in the
former of which, by reafon of the brevity in the hiftory of the fymptoms,
and in the latter, by reafon of no diffection having follow'd, we cannot affirm
the thing for a certainty.
1 8. A chafte and pious virgin, of four and forty years of age, who had
as yet had a plentiful and regular evacuation of blood from the uterus every
month, having this difcharge entirely obftructed for one or two months, be-
gan to complain of an itching of the eye brows and eyes, and of palpitations
of the heart, as fhe herfelf laid ; which were fhort indeed, but frequently recur'd.
Thefe palpitations being grown more violent of a fudden, and continual, I
was call'd in. The patient, then, in order to point out the feat of the diforder
to me, did not lay her hand upon her bread, but upon the epigaftrium.
Laying my hand upon this part, I perceiv'd a certain hard and large body
to be vibrating, and ftriking the hand with a great impetus. You would
have faid that there was a large aneurifmal tumour beneath the hand, which
every now and then doubled its pulfations, and occupied no fmall fpace in
the middle of the upper and neighbouring regions of the belly. And in this
light it appear'd to others.
My opinion, indeed, agreed with theirs in this ; that thefe pulfations had
no relation to the heart : inafmuch as there was no vibration in the breaft, and
the pulfe, when felt in both wrifts, fhow'd nothing different from the natural
ibite, except that it was a little more frequent. But in regard to the aneu-
rifm, I could not affent to their opinion ; not only for other reafons, but,
particularly, becaufe the times of thefe pulfations did not at all agree with
the times of the pulfes in the wrifts. For their intervals were very unequal,
as their force was alfo ; as ibmetimes the hand was ftricken with a very
ftrong, and, at other times, with a lefs ftrong impetus ; when, at the fame
time, not the leaft change was obferv'd in the pulfe at the wrifts.
Yet it was much more eafy to fay, what this tumour did not feem to be,
than what it did feem to be; being large and hard, as I have faid before, and
comprehended in the circumference of a circle, as if it were raifing itfelf up,
every now and then, from the vertebrae of the loins, to ftrike againft the
hand-, but immediately withdrawing itfelf in luch a manner, that, even in a
ilender virgin, it was not eafy to find out whither it had receded, till it again
rais'd itfelf up, and ftruck againft the hand. And although it came readily
to my mind, that a globular kind of tumours are frequently perceiv'd in the
bellies of hyfterical women, which afcending upwards from the lower part,
are very troublefome to them ; yet, on the other hand, it was equally obvious,
that thefe tumours are not attended with pulfations of this kind, fo as to re-
femble aneurifms.
Neverthelefo, c'onfidering this, and other things that might be faid againft
it, and weighing them in my mind ; and, at the fame time, attending
to thole things of an extraordinary nature, which are often met with in wo-
men, contrary to expectation ; I found myfelf inclin'd to conjecture that
(.v) N. 9.
wnatever
Letter XXXIX. Article 19. 377
whatever this diforder was, it might certainly be refer'd to the clafs of con
vullive and hylleric affections.
Yet this conjecture of mine I did but juft hint ; and omitting all contro-
verfy ; as my cuftom is, at the bed-lide 01 patients, when we agree, in other
refpects, as to the remedy ; I immediately alien ted to her lofing blood, as the
evident foregoing caufe requir'd. Which being done, the patient immediately
began to be io much lvttcr,.t!ut on the day following no palpitation any longer
remain'd. And Hie, certainly, did not complain of it again •, at lead for the
four or five months that I remain'd in the plate of my nativity, till, in the
year 171 1, I came here to take upon me the profefformip of medicine. But
by what diforder (lie was carried off, for llie died fome years after, I could
not learn for a certainty, as 1 was then here, and her body was not difiected.
19. The arteries which, if they are dilated into an aneurifm, may produce
a very great puliation in that part of the belly which is pointed out, in the
hiltory in queftioe, are the coeliaca with the largeft of its branches, the mefen-
terica fuperior, the right emulgent, and the great artery : but the latter of
thefe much the mod frequently of them all •, and the others very rarely, if
you except the cceliac. For to the caufes which are common to the others -,
as, for inltance, erofion, conftriction, and thofe of a fimilar kind, you
will, moreover, add, with me, this which is peculiar to the cceliac, when
you attend to thofe frequent tortuous flexures ; whereby, as the courfe of
the blood to the fpleen is retarded in the fplenic branch of that artery •, io a
great part of the blood, and the impetus of it, is reflected into the branches
which arife therefrom, before thefe obftacles are come to ; lb that if any of
thofe caufes be added, which continues to act very violently, and for a long
time together, an aneurifm may be eafily produe'd.
But although there are fo many arteries in that part, and more than one
caufe whereby they may be dilated, there are alio many things which ought
to render us cautious, left we, at any time, heedlefly take a pulfation for the
mark of an aneurifm being already begun. The firft is great leannefs and
thinners of body, as we even gather from what Berengarius (y) formerly
admonifh'd us of, in order to refute a miitaken opinion to the contrary, of
certain phyficians, in the cafe of an emaciated woman. His admonition is
as follows ; " by means of the great artery, a great pulfation is frequently
" perceiv'd in the region of the ftomach, and inteftines, and efpecially in ex-
*' tenuatcd bodies."
Nor did Profper Martianus (z) hefitate to explain from this caufe, even
that very great pulfation which is faid to have been juit in the very fame
fituation in the fon of Eratolaus, in the feventh book of Epidemics (<?), that
it was in the virgin I am fpeaking of; the words run thus: " in the middle
** fituation betwixt the navel, and the os pectoris, was perceiv'd, by apply-
M ing the hand to this region, fuch a palpitation as could not be generated
" about the heart, either by running, or by fear." Yet this, according to
the opinion of Martianus, " was nothing elfe but the motion of the great
CyJ Comment, g. fuper anat. Mundini. (a) N. 3.
(«) Adnot. ad vtrf. 55. feet 2. coacar. pra^
not.
Vol. II. C c c *c artery;
375 Book III. Of Difeafes of the Belly.
44 arrery, which is in others obfcur'd, and ftified, by the flefh that lies be-
" twixt this veficl, and the hand ;" for in that patient, in conftquence of
his being wafted away to the greateft degree conceivable, the thicknefs of
thefe parts, interpos'd betwixt the artery, and the hand, was fo diminifh'd,
that the artery " might not only be more eafily elevated, but more eafily
*' perceiv'd : and although this is common to all the arteries, of the body ;
14 yet it is, neverthelefs, obferv'd moft frequently," fays he, " in the middle
44 fituation betwixt the navel, and the os pectoris ;" the reafon of which is,
that there is no other part where a very large trunk of an artery is fubjected
to the hand, without the interpofition of any bone : and that in the fame
place, other arteries, which I have juft now taken notice of, exert their pul-
iations.
The fecond circumftance, whereby phyficians may be deceiv'd from pul-
iation, is very complicated : but, by the fame author Martianus (b)y is re-
duc'd to the fingle article of plenitude-, whether this be in the arteries, or in
the veins, or in the flefh •, which lying upon the arteries, and "comprefiing"
them, caufe their parietes to be elevated " with a greater impetus -," inftances
of which he produces in great inflammations, and thofe tumours that tend to
fuppuration. Yet Vallefius (c) had led the way to this doctrine, in the
narration of the hiftory of that patient, of whom I fpoke juft now. " A re-
41 markable pulfation happens in many patients," fays he, " in that part of
44 the belly, from the artery which goes down upon the fpine, by reafon of
44 an inflammatory affection of that part -, which pulfation fometimes happens
44 in acute difeafes alfo •, and fometimes even remains after acute dif-
" eafes and a cancerous affection happens in that place."
But that even where any hard body prefles upon the arteries, their pulfation
is perceiv'd, he had afTerted above (d), when he explain'd that " puliation and
44 weight," which were obferv'd in the belly of the wife of Gorgias (who had
labour'd under a fupprefTion of the menfes much longer than our virgin)
44 which way foever fhe was turn'd." For the uterus, fays he, 44 being in-
44 durated, is carried, like a foreign weight, to which-ever fide the body is
44 turn'd to •, and the arteries which are comprefs'd, endeavouring to free
44 themfelves from that compreffion, are perceiv'd to pulfate." In confe-
quence of which doctrine phyficians have fince obferv'd, as you even fee in
the Sepulchretum (e), that the coeliac artery, or the aorta, being comprefs'd
by a very great obftruction and turgefcency of the pancreas, or the mefenteric
glands, a violent pulfation is perceiv'd, as often happens in hypochondriac
patients, or others.
20. If you transfer thefe confiderations, and others analagous thereto, to
the virgin of whom I have fpoicen, you will learn, in the firft place, that the
puliation defcrib'd in her was not owing to an emaciated ftate ; for though
her body was (lender it was not extenuated. In the fecond place, although
there was fome plenitude, from the retention of the menftruous blood, yet
that it was not only from thence, for it was not in that place : nor yet from
inflammation, nor a tumour which verg'd to fuppuration ; nor, in fine, from
(l>) Annct. modo cit. (d) In 1. 5. n. 11.
(c) Comment, in 1. 7..epidem. n. 4.. (e\ L. 1. f. 9. in fchol. ad obf. 38.
any
Letter XXXIX. Article 20. 379
any confiderable obftruclion of the pancreas, or the mefentcric glands •, as of
all thele dileafes there were not the lcalt figns. It remains, therefore, that,
as thefc and other iimilar caufes of comprellion were abfenc, the puliation was
either from fome different caufe, or from an aneuriim.
What gave colour to the fuppofition of an aneurifm at firfl fight, was the
great bulk of body which itruck againft the hand. And if, as Albertini (f)
has afiertcd, he " has many times demon ftrated, from his not perceiving
M the diameter of the veflel to be incrcas'd, that the flrong and continual
'! pulfations of the coeliac artery, or of the aorta, in the abdomen, were
" without dilatation •, nor was the opinion invalidated by the event •" here,
on the contrary, a dilatation did not feem to be wanting, fince the pulfating
body was perceiv'd to have fo great a diameter.
I lowever, it nmft be confefs'd that it is not equally eafy to avoid being
deceiv'd, fometimes, in this fecond judgment"; that is to lay, when a body
of fome extent, which ftrikes againft the hand, may either be a dilated artery,
or a tumour lying upon an artery which is not dilated.
For if the artery is pretty large, and is compell'd, by the compreffing tu-
mour, to pulfate very vehemently, it will lift up the tumour with it ; which
we fuppofe to be not too heavy •, and will force it againft the hand of the phy-
fician. This circumftance, which every body fees fo plainly, that nobody
can deny it, happening fometimes even in the external parts, holds furgeons
in fufpence whether the diforder be an aneurifm or not •, as it did here in the
neck of a certain girl, who had a tumour fo contiguous to the left carotid
artery, that it not only caus'd ftronger pulfations of this artery, which it
comprefs'd, but even puliated therewith. Yet the whole tumour, as a more
accurate examination, and a perfect cure demonftrated, confifted in one of
the jugular glands being tumid, and already fill'd with pus internally.
So alfo, on account of the pulfation which was perceiv'd under a broncho-
cele, many had fuppos'd that tumour to be an aneurifm, which Severinus
(g) (as he believ'd it to pulfate, on account of its compreffing the carotid ar-
teries) fays he had, by diffecting it after death, demonftrated to be actually
of fuch a nature as his opinion had predicted. And if we are in danger of
falling into an error even externallv, how much more danger muft there be
of being deceiv'd, in thofe parts which lie deep among the vifcera ? See, with
what ingenuoufnefs, never fufficiently to be commended, thofe celebrated
men Jo. Phil. Burggrafius (h), and Peter Tabarranus (z), have deliver'd down
to pofterity what happen'd to them. The former, in a cafe wherein a pul-
fation was obferv'd from the navel, quite to the fcrobiculus cordis •, and that
to fo great a degree, as to be frequently heard by thofe who flood near ; and
which had continued for four and thirty years ; fufpecting it not to be from
a true dilatation of the large artery in the mefentery, as the diameter thereof
was not much enlarg'd-, but that it might be from a fpurious aneuriim, as
Lancifi calPd them ; and fuppofing it to be incurable, by reafon of having
continu'd fo long, law the puliation, contrary to all expectation, remov'd
(f) Comment, de Bonon. fc. acad. torn. i. (b) Aft. n. c. torn. 6. obf.' 131.
in opufc. (/) Obf. anat. -edit. z. n. ix.
{j>) De recond, abfcefl". nat. 1. 4. c. 6.
C c c 2 within
380 Book III. Of Difeafes of the Belly.
within a little time, by giving fome remedies, in the mean while, which
might, at lead, ferve to correct the crudity of the humours •, and this after
a great number of remedies had been made ufe of by others, to no pur-
pole.
But Tabarranus, having found not only a pulfation under the epigaftric
region, but alfo a tumour of the bignefs of a fift, and thofe join'd with the
other marks of a true aneurifm, was furpriz'd, afterwards, to find, inftead of
an aneurifm, only a fcirrhous tumour in the center of the mefentery, adher-
ing fo clofely to the large veflels, that it could not avoid comprefllng the
aorta, and being rais'd up by the pulfations thereof. Thefe obfervations may
be of fervice to you •, to me, at the time when I had the cafe of this virgin
before me, they could be of none, not only becaufe they were publifh'd fo
many years after ; but,, alfo, becaufe the pulfations, in both of the obferva-
tions, were made exactly at the fame time that they were made in the reft of
the arteries. Being induc'd therefore, by other doubts which I hinted at juft
now, to inquire into the remaining circumftances, I concluded that fo large
an aneurifm, as this muft have been, could not be form'd in lb fhort a time,
and without more violent fymptoms preceding or following it ; and that the
pulfations of an aneurifm could not but correfpond with the motion of the
arteries.
I therefore rather fuppos'd the tumour to be of fome other kind. That is to
fay, as I have hinted briefly above, I fuppos'd it to be the effect: of internal hy-
flerical convulfions ; which conftringing fome of the inteftines here and there,
and the mefenteric branches of the aorta, at unequal intervals of time, with a
very confiderable force, form'd, from thofe inteftines, a kind of globe, as it were ;
which was diftended with a confln'd and rarefy'd air ; and, at the fame time,
compelled the aorta to pulfate more vehemently, every now and then (in-
afmuch as the efflux of the blood from thence, into the mefenteric branches,
was prevented) and impel the globe which lay upon it. But as I had it not
in my power, as I have faid before, to demonftrate that no dilatation of the
arteries was conceal'd beneath that tumour, by difTection of the body, I will
go on to another tumour which was plac'd in the fame fituation, and this a
permanent one too,1 and examin'd by difTection. And as this was one of
the very rare tumours ; as the patient was a perfon of fo much confequence ;
and as the cafe gave occafion to fuch controverfies of opinion, that the hif-
tory thereof cannot, nor indeed ought to be, comprehended in a few words •>
you will not be furpriz'd if I give it you more at large than I generally do
others, and in an accurate and diftinct manner.
21. Fortunato Mauroceni, whom the love of a religious life had drawn
away from his illuftrious employments in the republic of Venice •, and from
his very noble family (for he was nephew, by the father's fide, of the Duke
Francefco, who took his furname from the conqueft of the Morea) into the
venerable family of the Cafmian monks, and whofe merits had remov'd him
from thence to the bifhopric of Trevifo •, and after that to the bifhopric of
Brefcia ; having from the very time he took upon him this new courfe of life,
come out very feldom in public, and us'd himfelf quite to a fedentary life, as
he was generally employ'd in the reading of facred books ; became, by degrees,
fubject to the hypocondriacal affection, and a flux of blood from the hemorr-
hoidal
Letter XXXIX. Article 2 1. 381
V
hoidal veins : yet, while this difcharge was in a proper proportion, he cnj<>\\l
a Itate of health, which was even more flourifhino; than he wilh'd : that is to
lay, a very fat habit of body, and particularly a fat belly ; till, at length, as
he grew in years, the hemorrhoidal flux at firft began to be diminiih'd ; and
after that to be entirely obftructed.
For when this difcharge was diminihYd, he was troubled with certain pains
of the belly, which he fuppos'd to be from flatus •, and were frequently hid-
den and momentary •, but lometimes of pretty long continuance. And when
he had now completed his lixtieth year, and no more blood was difcharg'd by
the hemorrhoids, thefe pains began to be more troublelbme, particularly in
the autumn of the year 1726, which was the laft he faw ; at which time he
alio labour'd under frequent fevers. Of thele he got rid by means of the
Peruvian bark •, and the pains were alleviated by the opportune return of
the hemorrhoidal flux. In the following winter, having his fever and pain
return a fecond, and even a third time, he was always reliev'd by the lame
flux coming on again -, but never perfectly cur'd : and, indeed, at this time
a certain hardnels firft began to be perceiv'd in the belly, and a tumour.
On account of thele dilbrders he came from Brefcia to Padua in the fol-
lowing fpring. With the other difagreeable circumftances was join'd acoftive-
nefs. To counteract this inconvenience, in as mild a manner as poflible, a
fenior phyfician prefcrib'd rhubarb to be chew'd now and then, mix'd with cur-
rants, from which the patient feem'd to be a little better: but fome ftronger
purgatives being added, by another fenior phyfician, he was much worfe ; as.
he was alfo by other things which were given him to procure ftools ; the pa-
tient being averfe to glyflers.
But even whatever remedy was given him, with a view to obviate other
fymptoms, he fcarcely had taken it more than once or twice, but he threw
k up again ; that is to fay, in confequence of its not being born on the fto-
mach ; which, in the mean while, being now frequently troubled with the
mod: obflinate vomitings, that yielded to no kind of remedy, threw up, very
foon, the food and the drink, that it took in ; or if it did retain any part of
them for a considerable time, brought it up at length, neverthelefs, without
its having undergone any change ; as was the cafe with a boil'd apple which
he had retain'd for eight and forty hours.
Befides his food, he alio brought up a great quantity of water, fo as even'
to exceed the quantity of what was taken in •, but this water had neither tafte,
nor colour : nor during the whole courfe of thefe vomitings, which were fo-
frequent, was any thing ever perceiv'd to be either bitter, or colour'd, if you
except the food. As thefe things, and others, but particularly the tumour,
(which I fhall fpeak of prefently) terrified the phyficians, that very eminent
man Michael Mauroceni the brother of the bifhop, knight, and very illul-
trious fenator, came hither from Venice, and order'd three other phyficians,,
in the number of whom I was, to be fent for, ir order to examine the pa-
tient, and confuk with his phyficians upon the cafe.
We found him confin'd to his bed, as he had been for fome days, extenuated
in his face and limbs, his flefh being warm like that of a healthy pertbn ; but
his pulfe rather more frequent : which two circumftances we were aflur'd
by his phyficians had always been fo j except that the frequency of the pulfe
5 was
382 Book III. Of Difeafes of the Belly.
was fomewhat increased towards the evening, and in the night. It was par-
ticularly begg'd of us that we would examine the tumour with accuracy.
This was, as far as we could judge from reeling it, and even from feeing it;
for it was obvious to the eye alio, nearly in the circumference of a circle, the
diameter of which was eight inches in extent, being plac'd in the midway
betwixt the cartilago enfirormis, and the navel •, in fuch a manner as to be
diftant from both of them by fome little fpace (fuch was the prominence of
his belly by reafon of fatnefs) rifing up from the circumference of it gently
towards the middle ; and having the fkin, wherewith it was cover'd, juft of
the fame colour that it was of in other places.
If you handled it, you perceiv'd it to be an unequally tuberous tumour in its
whole furface, and even in the very circumference of it, juft as if it had been
made up of glandular bodies ; which feem'd alio to be confirm'd by the refiftance
it gave when youprefs'd it. When it was prefs'd upon, and, in like manner,
when the patient was troubled with flatus, a fenfe of pain, but not very vio-
lent, arofe in the tumour : befides which accident, there was no complaint of
it, except of a fix'd, but flight, uneafinefs, as if from any little impediment.
By laying hold of the tumour with both hands, I eafily drew it to one fide or
other. That it did not occupy the parietes of the belly it was eafy to fee;
and, at the fame time, that it was, neverthelefs, very near thereto.
When I examin'd accurately with my hand what was above, below, and
at the fides of, the tumour, except that I did not go on to examine below
the navel, (the phyficians, and the patient, aflerting that nothing preternatural
was there) nothing hard or refilling was perceiv'd •, as far as the fat of the
belly, which lay between, would fuffer me to diftinguifh •, nothing unequal,
nothing which created any uneafinefs upon being prefs'd. Having made
thefe enquiries, and examin'd the urine, in which was nothing at all to be
found fault with, and the water that was, as I have faid, thrown up by
vomiting, and made every other inquiry, or examination, we thought ne-
ceffary, we retir'd, in order to compare our opinions with each other, before
that very illuftrious fenator, and a great number of other perfons, who were
eminent either for their dignity, or their learning, as well as thole who were
ftudents in medicine ; the phyficians, and even the prelate himfelf, having
.heard what I have already related to you.
22. When we were withdrawn from the patient, one of the phyficians,
under whofe care he had been, gave us a long diflertation upon the nature
and feat of the tumour, the fum of which was this ; that he believ'd the tu-
mour to be fcirrhous ; but a ipurious one, becaule it was painful when com*
prefs'd : and that it had its feat in the omentum, becaufe it was moveable
and external; or perhaps in the mefentery, if anyone Ihould choofe rather to
fuppofe thus ; for that this was moveable, and furniih'd with that large gland
which is call'd the pancreas afellii, the tumour of which might grow outwards
in fuch a degree, as to come to the anterior parts of the belly, as he faid he
had feen in a certain carcafe (as if that pancreas either were found in the hu-
man fubject, or as if it were poflible to draw the whole tumour of a gland,
plac'd in the immoveable center of the mefentery, as this pancreas is, to one
or the other fide, with the hand): as to the obftinate vomitings, it feem'd to
him that there was fome excrefcence in the ring of the pylorus, which pre-
vented the aliments palling through it •, and that thefe, when retain'd, irritated
the
Letter XXXIX. Article 23. 383
the ftomach -, or at leaft that the caufe of tliis vomiting was, certainly, not
beyond the ring of the pylorus, becaufe there never appear'd any mark of
bile in the matter that was difcharg'd.
He, therefore, afierted that, by reafon of the vomitings, the mod extreme
walling of body, and a How lingring death, could not be avoided in the end ;
but that on account of the tumour it might happen to be fpeedy, in confe-
quence of a purulent matter, together with blood, being efTus'd from thence
into the cavity of the belly. However, if any thing ftill remain'd for aphy-
fician to do, that this ought to be attempted by internal medicines, and non
by external applications. For as to letting blood from the hemorrhoidal
veins before the ftrength was broken down, that the patient had refus'd to
comply therewith when he had defir'd it •, and that now, in this ftate of weak -
nefs, there was no more room to think of it. That the [ acient had rejected
every thing which had been previoufly applied to the tumoi , not only as
ulelefs, but as heavy, and troublefome : wherefore avoiding every thing that;
might have the power of promoting fuppuration, the Ceratum Noribergenfo
was thought by him to be the moil convenient application •, but that we
ought to depend entirely upon internal applications •, that is to fay, upon fuch
as were ftrongly attenuating and diflblvent ; fuch as would open the belly
more than rhubarb-, and ftill more, fuch as increas'd the quantity of the urine.
In order to produce thefe effects, having recommended a great number of
remedies, and thofe of the more powerful kind, as his cuftom was •, he alio
laid that mercurials and chalybeates feem'd to him proper for the purpofe,
if they could be born by the patient, and were not difapprov'd by us, to>
whom he propos'd them.
After he had finifh'd fpeaking, the phyfician, who had attended with him,,
laid a few words on the fubject, patting by other circumftances of the cale,,
and only adding that he believ'd the liver and fpleen to be obftructed be-
sides •, but in regard to the medicines, he differ'd far from the other-, fayin«-
that he could not, in his confeience, propofe any thing but rhubarb as a pur-
gative-, as this was the only one which he had before made ufe of without any
inconvenience : whereas he had feen all the others which were added have
the mod difagreeable effects -, not only by creating confiderable uneafineflTes
for the prefent ; but by injuring the health of the patient. Then one of thofe
who had come with me, having fpoken fomewhat more at large upon the na-
ture of the tumour, and its feat in the omentum, and upon the exerefcence
in the ring of the pylorus -, which the former had fpoken of and threaten'd ;
particularly approv'd of this opinion : but in regard to remedies, he differ'd
from both of them. For he rejected every thing that is call'd purgative, and-
even rhubarb itfelf: but propos'd a decoction of the woods, as it is call'd,
with a fmall portion of the viper; unlefs this mould feem to be too heating,
on account of any feverifh difpofition.
23. I, however, altho' I faid that there were four things which ought to be
chiefly attended toby us, the tumour, vomiting, wafting of fiefb, and fever ;
neverthelefs commended thofe who had fpoken before me, for having had a
particular regard to the tumour, which, as it had been antecedent to the other
diforders, might alfo feem to be the caufe of them. I likewife faid that the
caufe of the tumour might, certainly, be fuppos'd to confift inthelefs quick.
5 motion.
384 Book III. Of Difeafes of the Belly.
motion of the blood thro' the vena portarum ; which the patient's fedentary
Hate of life, the hypochondriacal affection, and the flux of blood by the hae-
morrhoids ; that was of ufe at the time of its flowing, or returning, but hurtful
when it decreas'd, or quite fell away •, pretty clearly prov'd.
From this retarded motion therefore, that irritations, crifpatures, and
pains had arifen; and, finally, the beginning of a tumour, in lbme one of
thefe parts, from whence the returning blood is to be receiv'd, into that vein.
That there were other parts which transmitted their blood to the vena porta-
rum, befides the omentum, and mefentery, but particularly the inteftines ;
which were, in fact, more near to the hands of any perfon who touch'd the
abdomen, than the mefentery itfelf ; and not lefs moveable to one fide and
the other, than the parts of the mefentery annex' d thereto ; and even much,
more lb than thofe, in particular, that are neareft to its center.
To this, I faid, we may might add that, on fuch a fuppofition, we could more
eafily account for, not only the long coftivenefs of the bowels, but perhaps,
even the vomiting, which had fo frequently been brought on. For that thofe
fmall inteftines, which lie in this region of the belly, being conftrieted, the
diameter of the pafTage was not only diminifh'd, and the periftaltic motion,
in fome meafure, obftructed ; but even that fome part of the irritation would
be propagated, without any difficulty, to the neighbouring ftomach, into
which they were continued. And indeed, that the pain which arofe in that parr,
from preffing with the hand, or even from the inconvenience of flatus,
would be much more clearly underftood, if we fhould fuppofe the tumour to
belong to the inteftines themfelves.
Neverthelefs I defir'd I might not be underftood, as if, by faying thefe
tilings, I meant to prefer my opinion to that of others, as I would fubmit it
to the confideration of all •, fince I would not pretend abfolutely to determine
on any thing, in an affair fo difficult, and obfeure: and therefore did not de-
fpife the opinion of others. For although I remember'd frequently to have
read of large tumours in the omentum, without the mention of any pain
(k) •, and had even determin'd, with the confent of others, a tumour to be of
this kind which I met with in the wife of a phyfician, who was of a full
habit, and of a good colour, and felt no inconvenience therefrom, not even
pain when it was prefs'd ; yet that there may be, fometimes, a tumour in the
omentum of fuch a nature, hardnefs, and fhape, that by preffing it, either
in that parr, or in the parts contiguous, a pain may be excited : of which
circumftance I knew that fome learned men had not doubted (/).
But as to large tumours of the mefentery, that they, by pufhing the in-
teftines, and the omentum to the fides, lie immediately under the anterior
parietes of the belly, and are contiguous to them, may be confirmed by more
than one obfervation (m) of phyficians, and anatomifts. Moreover, that the
difficulty of diftinguifhing the true fituation of a tumour, was increas'd in
(&) Wharton adenogr. c. 12. vid. etiam fuis (w) Vid. River, prax. med. 1. 13. c. 5.
Jocisplerafqueobferv. indicatasinhacSepulchr. Wharton. 1. cit. c. n ; Scultet. armam. chir.
i'eci. 21. fub obf. 33. itemque in addiiam. obf. obf. 62. &caet.
73.80,85. 88.
(I) Vid. feci, modo cit. fchol. ad obf. 54. 85
in uudit. obf. 80. verf. fin.
bellies
Letter XXXIX. Article 23. 385
bellies of this kind, which are far, large, and iubject to flatus and tormina of the
bowels. For befides that a great quantity of fat, lying betwixt the hand and
the vifecra, is an obllruction to our examination, there are, frequently, in Inch
bellies as thefe, vifceraj and, particularly, fome of the inteftines 5 drawn, or
forced, out of their fituations. But as there may be more than one feat of
pain, fo that there may be more than one cauie of a very obftinate vo-
..miting.
Nor indeed did it efcapc "me, that from the ring of the pylorus itfelf, a
kind of excrefcence fometimes arofe, fuch as I had often feen; which, it it
be pretty large in its fize, as a certain ftcatoma was in a phyfician well- known
to lbme of my friends, may prevent the paffage of the aliments : yet that,
at the lame time, I was by no means ignorant how many caules there may be
in that place, or near to that place, both internally, and externally, pro-
ducing the lame effects •, fo that if we even reckon up a great number, we
Ihall perhaps not hit upon the true one. For, to mention one cafe by way of
example; the coats of the ftomach being, every where about this pafiage,
grown hard, and thick, that the pafiage becomes much narrower than it na-
turally is, and the aliments are not propell'd ; which kind of difordcr had
been found at Padua, in a prieft ; and not only in others of whom I had
read in other places (;t), as well as in the Sepulchretum (o).
And not to fay that juft the fame effect would be produe'd, if any one of
the diforders fpoken of, fhould befet a part of the duodenum, that was neareft
to the ftomach (p) : there certainly was an obfervation extant in the Sepul-
chretum (q), of a cafe not very much unlike this, if I remember'd rightly,
whereof we were fpeaking ; fo that the queftion about the tumour of the
omentum had recall'd it to my memory : for as the omentum had a large tu-
mour in the epigaftrium, of the hardeft fat, the pylorus was fo conftricted
by a fimilar matter, which lay around it, that from hence an incurable vomit-
ing, an obftinate coftivenefs, and a wafting of flefh had been brought on.
Of this laft mention'd fymptom there was no occafion to fay much, in re-
gard to a patient, who not only threw up his aliments, but even a greater
quantity of fluid than he took in : whether this water was from faliva, which
often defcended in great quantities into an empty ftomach; or even was prefs'd
out from the coats of the ftomach itfelf, by the frequent {trainings to vomit:
although fome part of the chyle, which was prepar'd from the very few in-
gefta that pafs'd into the inteftines, might, moreover, be intercepted by the
tumour, which belong'd either to the inteftines, or to the mefentery.
From this tumour, or at lead on the account of this tumour, fome parti-
cles that have ltagnated long in the belly, and have, for that reafon, become
deprav'd, may, upon their return into the blood, have fo irritated the heart,
and arteries; that, Anally, I was at liberty to conjecture the origin of the
fever, in this, or lbme other fimilar manner.
From what I had hitherto faid of the four articles propos'd to be con-
fider'd, in the beginning ; although it appear'd wherein I differ'd from the
others ; it was, neverthelefs, eafy to conceive that I could not but agree with
(/;) Vid. epift. 30. n. 13. (p) Vid. confirmatum epift. 30. n. 1 2.
(a) L. 3. f. 8. obf. 17. & feq. (j) L. cit. f. 21. obf. 80.
Vol. II. Ddd them,
3S6 Book III. Of Difeafes of the Belly.
them, in determining the diforder to be incurable. And this I readily
confefs'd : I only added this one thing, in particular -, that I was afraid
left the tumour might bring on death in fome other way, rather than by
an effufion of pus; the figns of which were not, at prelent, very near at
hand.
That it became us, therefore, in an incurable difeafe, to ufe all our ef-
forts, that life might be prolong'd to as great an extent as pofiible ; by refitt-
ing, as much as it was in our power, the caufes that might accelerate death.
That in the number of thele caufes vomiting was to be confider'd, in more
refpects than one-, by bringing on a wafting, by diminifhing the ftrength, by
giving concuflions to the tumour. And if the chief cauie of vomiting could
not be remov'd, yet that another might, at leaft, be diminifhM ; which, in fome
meafure, perhaps exafperated the former, as it generally does •, that is the coftive-
nefs of the inteftines. That the bifhop was by all means to be entreated to
fuffer clyfters to be made ufe of, which would have this effect; or if they
were adminifter'd without the defir'd effect, would, at leaft, ferve for nou-
rifhment. But if he perfifted in refufing to admit of them, and if rhubarb,
in the method prefcrib'd above, had really fufficiently obviated the coftive-
nefs, without any inconvenience, that I had no objection to the ufe of it ; not
fo much becaule I approv'd of it, as becauie other purgatives were partly not
fuitable to the cafe, and partly were evidently hurtful ; and that I was there-
fore indue'd, and compell'd, by the neceffity of the cafe, to admit of h.
However, that all irritating and unpleafant medicines were to be avoided ::
and therefore I did not disapprove of a fmall portion of the viper •, which
might, without the knowledge of the patient, be boil'd in broth?, and admi-
nifter'd by way of nourifhment ; unlefs they fhould rather choofe to difiblve
fome of the jelly of the viper therein: for that the heat of the viper could
not poftibly be of any diflervice, in fo fmall a quantity of either one, or the
other, while the fever was thus flight ; nor even if it were fo great as molt of
them feem'd to imagine. And that I faid nearly the fame things, of a pro-
portionable quantity of larfaparilla, or rather of china-root.
As to the propofal of giving mercury ; I faid, in the firft place, that the patient
had not ftrength enough to fuffer us even to think of it : and if he had, that I
fhould much more readily approve of a imall blood-letting from the hemor-
rhoidal veins, as moft agreeable to what I had faid of the tumour: and in the fe-
cond place, that if the nature of the tumour was iuch as they judg'd it to be,
which I could not take upon me to deny; I mean that it feem'd, to the touch,
to be evidently made up of fcirrhous, and ftrumous glands ; certainly mer-
cury was lefs proper than millepedes : and that thefe were more proper, like-
wife, on account of its being probable that they would prove diuretic at the
fame time, if this effect were really of the importance that had been fup-
pos'd. But that nothing was of more importance than to lengthen out life,
as I had already faid ; and that this might be brought about by omitting
every thing that was diftafteful, and giving fuch things as were more grate-
ful, and nourishing. And that we ought diligently to attend to the manner
in which the ftomach is affected by thele different things, in order to make
the chief ufe of thofe which have been retain'd the longeft, or "not wholly
thrown up.
5
24. Al-
Letter XXXIX. Article 24, 25. 387
14. Although I could not be lb fhort in this cafe, as I generally am in me-
dical consultations j yet the phyfician who Ipoke Kill made a ftill much longer
harangue: he was an elderh man, ami a celebrated profcilbr. The amount
of his (beech was this -, that he acknowledg'd the. nature of the tumour to
be the lame ar the others thought it : luit he fuppos'd it could have no other
fituation than that of the uiefentery, the omentum (for of the inteftines he
did not fay a fingleword) being put out of the quelfion, chiefly fortius re*-
fon, becaufe ir was without lcnfation, and could be cut into without pain.
However, he confirm'd the opinion of the diforder being incurable: ap-
prov'd of medical aliments, and among thefe the viper in particular: he com
demn'd purgatives, and all violent remedies : but not fo millepedes j as he
rcmembei'd a poor girl to have been cur'd of a ftruma, by the ufe of
them.
You have now, then, the fummary of whatever pafs'd in the confutation.
But do not wonder that, although I have given, brielly, the opinions of four
phyficians, who flourifh'd here, and were more eminent than others, at that
time ; I have, neverthelefs, been more diffuie in explaining my own : for
this I have done that J might be lefs prolix, in accounting for thofe appear-
ances which were found in the body of the bifliop, after death •, which hap-
pen'd about the twenty eighth day after our confutation. But let us finifh the
hil'tory of the difeafe that I had begun.
25. What the two phyficians, to whom the cure had been committed,
did afterwards, I never, in the leaft, inquir'd ; nor indeed is it my cuftom,
after I have given my opinion. Yet I heard, as did every one at Padua,
that they had given rhubarb on the day following •, but not within the former
bounds; and, therefore, not without great uneafinefs to the patient: and that,
at length, they had perfuaded the patient to admit of clyfters fometimes ;
and, by this means, had procured ftook with fome advantage. Lad of all,
when it had happened that two days were pafs'd over without any vomiting, I
heard that expectations had been fpread abroad among the populace, of the
recovery of the patient ; which I could wifh had been accomplifh'd ; but from
what fource this prevailing hope arofe, I cannot tell.
Soon after, however, I heard that the vomitings had return'd, and even in
a more violent manner than before. In the mean while a foreign phyfician
came hither, who was, in the opinion of the people, very excellent : and
he, they laid, had here pronoune'd this cafe to be defperate •, but had added,
in fome other place, that he could have overcome the diforder by means of
mercury, if he had come fooner. Nor indeed was one wanting, when he
was gone away, who promis'd, without the leaft hefitation, to cure the patient
by a certain remedy of his. This was an infufion of what is call'd. the lignum
nephriticum ; wherewith he, perhaps, might have difcufs'd fome hardneffes
of the belly, at Venice. He gave it feveral times to the bifliop, but in vain.
And now his wafting of fiefh being increas'd every day, and his ftrength pro-
portionably decreafing, the diforder haften'd to its end.
At a certain hour the patient call'd out for more bed-clothes, as if he
were cold •, whereas, at other times, he could bear only the lighted cover-
ings •, that is by reafon of the heat, but an internal heat: for externally, no
perfon ever perceiv'd his body to be cold, or hot, but always gently warm.
D d d 2 His
388 Rook III. Of Difeafes of the Belly.
His re fpi ration was never bad. His pulfe was neither hard, nor intermit-
ting •, nor ever, in any meafure, unequal : but had become very frequent, on
the lalt days of his life, and fo low, that by one of the phyficians it
was fuppos'd to be quite loft. To this was added convuliive ftartings of the
tendons, and fometimes a very flight delirium. On the fame laft days, the
vomitings dill continu'd ; but the matter difcharg'd was bitter, and fmelt very
itrong •, and was fo very black that fome thought it to be blood : but a piece
of paper, that had been dip'd into it, appear'd, after drying, to be of a dilute
yellow colour, inclining to green ; which fhow'd the humour difcharg'd to be
bile. In this manner the patient ftruggled on to the twenty-thiid day of
June ; on which day, in the afternoon, he was attack'd with fo very violent
a paroxyfm, that it was fuppos'd he would have inilandy died. Ne-
vertheless he efcap'd. But the fame paroxyfm returning, on the following
day, at the fame hour, this excellent prelate ; being perfectly in his fenfes,
and every now and then pronouncing fome pious words, with a low voice ;
having turn'd himfelf to one fide, without any affillance, which on the
former days he could not have done •, foon after departed this life in a placid
and ferene manner.
26. As the body was to be embalm'd in the evening, in order that the fu-
neral rites might be perform'd on the third day after, all of us, who had
given our opinion on the cafe, were call'd to the operation. And there, af-
ter having heard from the phyficians of the bifhop, and his houfhold-priefts,
thofe things that I have related to you as undoubted facls, concerning the.
latter part of the difeafe, I prefently after prelided at the direction, while I
was lurrounded by my fellow-phyiicians, and a great number of ftudents.
The abdomen, although the limbs and the face had been much more exte-
nuated, than this part ; had, neverthelefs, fo far fubfided, that, even from
this caufe, it might be fuppos'd the tumour had rifen up, and become pro-
tuberant, outwards, more than we had feen it before. Neverthelefs, under the
fkin of the abdomen the fat was, univerfally, two inches thick.
The cavity of the belly being laid open, into which a bloody ferum had
been extravafated, to the quantity nearly of three pints, two circumftances
drew the eyes of every one upon them at once. For, on one hand, appear'd
the tumour, of which there had been fo much controverfy, in the form of a large
globe •, or rather like a large hemifphere •, having the refemblance, if you at-
tended to the colour, the foetid fmell, and the inequality of furface, of a moll
foul cancel-. And, on the other hand, which was a very ftrange, and unufual
fpeitacle, the whole of the fpace contain'd within the belly, from the navel
downwards, was, univerfally -, if you except the left and inferior part of the
colon, and the rectum, with that part of the mefocolon belonging thereto,.
and the urinary bladder ; entirely free from vifcera, and empty. And from
hence it came immediately into my mind what the tumour was : and this fuf-
picion was confirm'd, firft, by my own infpection ; and then by the infpection
of every one. That is to fay, the whole inteltinum ileum, and fome part of
the neighbouring jejunum, having left their fituations, which are, naturally,
below the navel •, and being drawn upwards, and join'tl together very cloieiy,
had, of themselves, compos'd this large and prominent tumour, without the
leaft addition of any fcrophulous, fcirrhous, or cancerous fubftance.
Foe
Letter XXXIX. Article 26. 389
For the inequality of the furface arofe from thofe frequent flexures of the
irtteftines, and their unequal pofition, and conftriction ; lo that they protube-
rated more in t j 1 1 c part, and lels in another : but the blackifh colour, which
was almoft univerfal j I mean which had only fome .lellcr fpaces interpos'd that
were ilill reu ; was manifettly owing to the inflammation of the inteftines,
which had already degenerated, in great meafure, into a gangrene •, doubt-
lefs from the return of the blood into the vena portarum being, at length,
intercepted-, the retardation of which I have ipoken of above (r) : and, final-
ly, the ill fmell was the confequence of the gangrene, as it naturally is. The
inteftines of which the tumour was made up, were almoft full of matter, like
the ftercoraceous matter generally contain'd in the large inteftines, and not very
foft, as we found by laying one of them open afterwards ; lb as to make it
evident that the matter which naturally defcends fpeedily into the large in-
teftines, being obilrucled, and having flatus join'd to it, the tumour might
give that refinance to the touch, which we had perceiv'd in the living body.
And, although by realbn of the clofe connexion of the inteftines one with
another; which I mention'd before •, there was occafion to take a very long
time to feparate them by means of the fcalpel (for drawing them on one fide,
and on the other, with the hands, was of no effeft) yet about the middle, and
almoit thcupperpr.it, of the tumour, the feparation being lels difficult, it was
brought about in this part, at leaft, and the interiors of the tumour brought
to view; which were, in like manner, made up of inteftines heap'd together
beneath, and, in feme part of the mefentery, which was neither grown hard,
rtor thick, nor of a black colour, that any of us could diftinguifh ; but per-
fectly found, and fill'd with fat ; which was, as it naturally is, of a white co-
lour, inclining to yellow.
As the omentum had not appeared, in any degree, hitherto, I turn'd my
eyes to the upper region of the belly ; where the ftomach was funk down be-
twixt the defcrib'd tumour, and the diaphragm : and as it did not very well
appear, even by thefe means, but feem'd to be a kind of hard, thick, and
heavy band, fixing itfelf clolely to the fundus of the ftomach, and the inte-
ftinum colon, that lay beneath the ftomach; paffing trar.fverfely from one hy~
pochondrium to the other ; and deprefiing both the ftomach, and this large
mteftine, by its weight, and thicknefs ; I was, at length, fcarcely certain that
it was really the omentum, till it had beenconfirm'd by the others, as well
as by myfelf, from the due consideration of all circumftances.
For the fmall inteftines, rifing into a tumour, had long ago driven the
omentum up into that part; and there, being folded up together, it had
coalefc'd into one hard body, like a falcia, or band, of an equal furface, but
not of an equal thicknefs. For, in fome places, it was of the thicknefs of
one inch, in others of two, and in fome again of three ; as was clearly per-
ceiv'd by the lections : but the greateft thicknefs was oblerv'd to be near the
fpleen in particular, as a rigid hardnefs was alfo ; fo that when it was cut
into, the fubftance thereof grated under the knife: however, to the fight the
fubftance was every where uniform ; but the hardnefs was, in fome places, of
the ligamentous kind as it were, and, in others, almoft cartilaginous.
W N, 21.
la
39° Book III. Of Difeafes of the Belly.
In this (late then was the omentum •, which did not fall under the notice of
the touch in the living body : inalmuch as lying betwixt the great quantity of
fat of the abdomen, and the yielding vifcera, the ftomach, and the intefti-
num colon ; and by reafon of its deprefs'd fituation, and its very firm con-
nexions ; it could neither be laid hold of betwixt the hands, as that promi-
nent tumour of the inteftines could be, nor mov'd to which-ever fide you
pleas'd. The ftomach was then examin'd. And after having exhaufted all
the contained fluid •, which was in great quantity, of a blackifh colour, had a
very filthy fmell, and was, in every refpect, fuch as had been thrown up in
the laft vomitings ; the internal furface of it appear' d of a reddifh colour, in-
clining to brown ; which, perhaps, might be the confequence of being ting'd
with the humour I have defcrib'd -, or might poflibly be the effect of inflam-
mation.
But in the antrum pylori, it feem'd, here and there, diftinguiflfd with cer-
tain fmall coagula of blood, as it were ; which, when more accurately exa-
min'd, were found to be nothing elfe but fmall and deprefs'd tubercles, inter-
nally, indeed, firm and white, yet, on the furface, affected with a gangrene :
fome of them were of an oval figure, and others had different figures and po-
rtions •, but the greater part were made up of many, in fuch a manner as to
>refemble branching afterifks, as it were, or afleriiks furnifh'd with inflected
and bifurcated radu. Yet the more near they approach'd to the pylorus, from
£he beginning of the antrum, the fmaller and lefs frequent did they become,
Jfo as at length to be quite folitary. That which was the largeit of all fcarcely
reach'd the magnitude of a bean.
In the pylorus itfelf, neither thefe tubercles, nor any excrefcences, were
•obferv'd : and, indeed, the paftage through this part was not fo much con-
tracted, as to prevent a finger being introdue'd into it, according to my de-
fire. Yet there were in this part, and in almoft the whole antrum of the py-
lorus •, and, in like manner, in the firft part of the inteftinum duodenum,
which was neareft thereto, fo very thick and hard coats, that, as they equall'd
the point of the finger in thicknefs, fo they did not yield much, in rigid
hardnefs, to the omentum that I have defcrib'd-, to which they were likewife
iimilar in their hard and compact fubftance: and from this very fubftance,'
rifing up into little prominences, in fome places, thole tubercles were form'd,
which 1 fpoke of before.
The liver was internally and externally pallid, and fomewhat hard, but of
its natural figure and fize. The gall-bladder contain'd a bile like a blackifh
mud. The i'pleen, and the other vifcera, were found, as thofe of the thorax
alfo were ; where the pericardium and the heart were feen to be cover'd over
with fat. One vifcus of the belly, however, muft be excepted •, and that is
the pancreas : but as I was about to proceed in my inquiry into the ftate of
this vifcus, my collegues began to be tir'd •, and to think, as the night was
now far fpent, and the fmell extremely offenfive, and as thefe very firm con-
nexions of the omentum could not very foon be diflblv'd, in order to lay bare
the pancreas, that the difiection had been fufHciently profecuted.
27. And, indeed, if you attendedtowh.it had preceeded, efpecially to the
tumour j on the particular nature and fituation of which the controverfy had
.been agitated during the life of the patient j the inquiry feem'd to be carried
furEciently
Letter XXXIX. Article 27. zgr
Sufficiently far. And as I was returning from the dificchon, together with
my companions, being aik'd by a very grave man, what appearance had, at
length, been found ; 1 immediately anfwer'd, for all of us, nothing but what
had been previoufly hinted, in fome meaiure, in our coniultation, and jullly
pronoune'd incurable. Nor did I conclude the narration in any different
manner, when I wrote to that eminent fenator, fpoken or above (s \ brother
to the bilhop •, when, on the day following, I lent the fummary, of what had
been obferv'd, to him, as my duty and rcfpecT; oblig'd me: and this, as it was
acceptable to him, he kept by him.
Nor, indeed, although I afterwards heard that one, and another fummary,
of thefe things, was in the hands of every one, would I, for that reafon,
give out mine •, as well becauie they were much more different from one an-
other, than they were from mine, as becauie I was never willing to begin un-
neceflary controverfies. And what could be lefs neceffary, than fuch as could
be determin'd by the teftimony of the furgeons who had perform'd the dif-
fection ? And this I took care to procure \vhen the fubje£t was quite recent ;.
not in order to produce it then, but only to have it at hand, as I actually
have, if, at any time, I fhould produce the whole obfervation ; and any one
fhould be in doubt about the ftrict juftnefs of my narration, from having pe-
rus'd any part of their lummaries, which was fomewhat different.
But I fhall not now fay what was wanting in thefe lummaries, or what was
fuperfluous; or, finally, what was different from the truth: nor, indeed,,
fhould I have made any mention of them, if I had not fuppos'd that they
had, probably, been feen by you, fome time or other ; and that you would,
wonder at my taking no notice of them. I fhall only tell you this that was
then laid by all the others, who were prefent at the diffection : that one phy-
fician very properly confefs'd the tumour, upon which there had been lb much,
controverly, to confiftof thefmall inteftines join'd and heap'd up together into-
a large globe; but this was laid without juftice, that it had alfo confided of
" the mefentery, which was become very hard, and of the fame colour" (that
is to fay, " black and gangrenous") with which the inteftines were tinged ;
and, finally, that it was " tumid."
So alfo, on the contrary, 1 will fay that another of them, with juftice, af-
firm'd the mefentery to be M white, and without any tumour, or hardnefs •,"
but thole things were not laid with propriety ; when forgetting that he him-
felf had, in the confukation, conjeclur'd a fcirrhus of the mefentery, as well
as of the omentum (7),. hecarp'd, not without fome feverity, at him who had
fuppos'd a fcirrhus in the mefentery ; and, in like manner, where he dif-
eours'd upon the coalition of the inteftines, and the fcirrhus of the omen-
tum, with fuch artifice, that any one, who was ignorant of the affair, would
not lb much as fufpecl: the inteftines to have been heap'd up into one globe»
and to have rifen up into a tumour ; but would fufpe6t, for this reafon, that
the tumour in queftion had been made up, chiefly, by the fcirrhus of the
omentum ; nay, would even certainly fuppofe, that this tumour was nothing
elfe but the fcirrhus of the omentum •, which did not, however,, begin " in,.
" the upper part of the navel," but much higher ; nor was in the leaft de-
legated, but lay quite fmooth and deprefs'd.
(/) N. 21. (t) Supra n. z?.
How
392 Book III. Of Difeafes of the Belly.
How much more would it have become thofe two fenior phyficians, to have
given up all controverfy upon the fituation of the tumour ; which could now
exift no longer with any propriety •, and imitate the illuftrious example of
Hippocrates (u), and Galen (x), by candidly confeffing that they had been
clecciv'd in their conjectures, on the nature thereof ; fince it was not very pleaf-
ingto me, who was the only one that had hinted at the real feat thereof, not
to have been able entirely to avoid a tacit fufpicion of having been deceiv'd,
in regard to its nature, in common with the reft-, but ftill lefs lb, to have had
this fufpicion fprcad openly among the people.
2S. It is of great importance for thofe who are given to the (ludy of medi-
cine ; and of a great importance to you, on whofe account I have undertaken
this long difcourie ; not to be ignorant that a tumour once exifted in the belly,
which ; although it was made up of the inteftines themfelves •, being, never-
thelefs, of an unequal and tuberous furface, and giving confiderable refin-
ance to the touch, had impos'd upon five phyficians ; and thofe, if you ex-
cept me alone, very fagacious, and experiene'd men •, under the appearance
of afcirrhus. And who can inquire into the marks by which this diforder may
be diltinguifh'd, unlefs the diforder be made known by our ingenuous con-
feflion ? Nor, indeed, will thefe figns be eafily found among our authors ;
iince I do not remember to have read a hiftory any where that was perfectly
like this.
I have read, indeed, in the acts of the Casfarean academy (y), " that all
*c the inteftines were found to be clofely cohering to each other " or " the
" fmall inteftines in particular, fo very clofely grown together with one an-
" other, and with the mefentery, every where, that" they made up "onemafs,
" or one conglomerated heap," therewith : and indeed I have read that, in
a young woman, who had been frequently fubject to pains of the belly, the
celebrated Fantonus found (z) " almoft all the inteftines gathered up into one
" conglobated body, as it were, and very clofely conglutinated with each
'* other: and you may read in this twenty-firft fedlion of the Sepulchre-
turn (#), " that all the inteftines were conglomerated, and form'd into a kind
" of globe:" and, in like manner \b\ " that the inteftines were fo drawn up
" to the fuperior parts, as fcarcely to fill half the capacity of the abdomen."
But in none of thofe obfervations will you find that they were fo drawn
up, and conglobated, as to be externally prominent in the form of a circum-
icrib'd and particular tumour: and in the two laft this even could not have
happen'd, as the bodies were in a dropfical ftate, and a great quantity of wa-
ter was interpos'd, fo as to diftend the whole abdomen : as it likewife could
not happen in another dropfical woman, in whofe body Thomas Bartholin (c)
law " all the inteftines thruft afide to the right hypochondrium •, fo that, at
" firft, they feem'd to have been wanting ■" or in a foldier, who, alfo, had
labour'd under an afcites'; whofe inteftines I.aubius (d) found " furprizingly
*' intwin'd, and collected together, into one globe, as it were, towards the
•« navel."
(u) Epidem. 1. 5. n. 14. («) Obf. 3. §. 8.
(.v) De Loc. afF. 1. 2. c. 5. (bj Obf. 20. %. 6.
(j>) Tom. 1. obf. 87. & torn. 6. obf. 134. (c) Cent. 1. hift. anat. 2.
{z) Dc obferv. med. & anat. epift. 4. (if) Eph. n. c. cent. 9. obf. 64.
^.nii
Letter XXXIX. Article 28. 393
And this, perhaps, might have been the cafe; though it is not exprefly
laid to have been fo i in Cardinal Campegio, in whole body " all the in-
" teftines" (part of the colon and the rectum ought to have been excepted)
" were fore'd together into the hypochondria ; tor which reafon the interior
" cavity of the abdomen was dtllitute of inteftines, and the fpine un-
" cover'd," as Columbus law (e) ; " the novelty of which circumftance,"
that was alio feen by us in the bifhop, M could not," fays he, " be fufficiently
" admir'd by the excellent Auguftino Ricci of Lucca."
A ftill more furprizing novelty of this kind, I afterwards met with in a
female foetus. For upon opening the belly, and wiping away the blood that
was extravalated therein, no inteitine, belide thole that I juft now excepted,
was any where to be feen j as all die others, with almoft the whole of the
mefentery, lay hid under the concave furface of the liver-, and were confin'd in
luch a manner, as I fhall, perhaps, explain to you on a more convenient oc-
cafion (f). But this nobody could have fufpecled before difiection ; becaufe,
by reafon of that quantity of blood being extravalated, the abdomen did not
fubfide, below the navel : and if it had fubfided, who would not have ima-
gin'd that it was to be imputed to the liver, which is always large in a foetus,
being, perhaps, much enlarg'd here, rather than to the inteftines being
drawn up behind the liver?
For Philip Jacob Hartmann (g) had, indeed, alfo feen a large tumour, in
a girl of three years old, ftretch'd out from the left fpurious ribs, to the con-
fines of the pubes ; nor could he poflibly have fuppos'd it to be made up of
" the inteftines coalelc'd into one body, with the greater part of all the me-
fentery ," fo that " the back was the only part which lay confpicuous to
" the fight :" yet he has not added any thing, whereby, if the fame fhould
happen again, the nature thereof might be known. Columbus, however
(£), had intermix'd fome things, from whence we might collect a few marks
to diftinguifh it by. " Wherefore," fays he, the phyfician, when examining
*' the belly of the cardinal with his hand, might plainly feel the motion of
" the great artery-, and together with that, perceive a hardnefs; which hard-
" nefs was nothing elfe but the bodies of the vertebras."
Thefe marks it was not in my power to make ufe of in the bifhop, as I
did not examine his belly below the navel -y for the reafon I have given you
above (i) : and even if I had made this examination, I fuppofe I fhould have
perceiv'd neither of thefe marks, by reafon of fo great a quantity of fat being
interpos'd ; or, at leaft, not the motion of the great artery ; or of the begin-
ning of the iliacs ; as the pulfe was neither ftrong, nor large : for which rea-
fons neither the phyficians, nor the patient, feem to have obferv'd it ; as they,
otherwife, would not have denied that any thing preternatural was perceiv'd
below the navel.
But in thofe wherein the abdomen has lefs fat, thefe marks will not be
without their advantage -, provided there is fome fat, and no fufpicion of the
-great artery being dilated in that part, or pulfating immoderately, from any
other caule : for in thefe cafes, not only the puliation of this artery is per-
ceiv'd, even when the inteftines lie betwixt, as is mown in this letter (k) -t
(e) De re anat. 1. 15. {b) Loo citat.
(/) Vid. epift. 67. n. 17. (0 N. 21.
(e) Eph. n. c. dec. 3. a 9. & 10. obf. 105. (k) N. 19.
Vol. II. E e e but
394. Book III. Of Difeafes of the Belly.
but the hardnefs of the vertebrae alfo ; as I have faid in another (I). In a
body, therefore, that is neither fat, nor very thin, nor liable to thefe fufpi-
cions, if a pulfation be perceiv'd ; and ftill more, if that hardnefs be per-
ceiv'd at the fame time •, we fhall conjecture the inteftines to be drawn up-
wards : and it will add no fmall weight to the conjecture, to find that the
abdomen is more deprefs'd below the navel, than it ought naturally to be ;
and more turgid above at the fame time.
But if, together with thefe figns, a peculiar and moveable tumour arifes
in the upper region of the abdomen •, fuch as has been defcrib'd in the
bifhop while living (*»)•, we mud not only take care, left, by reafon of the refin-
ance, and inequality, or tuberofity, of furface, we readily refer it to the clafs
of fcirrhous, or ftrumous tumours •, butwemuft, moreover, inquire by what
fymptoms we may rather be induc'd to fuppofe that it is made up of the in-
teftines. Thefe fymptoms will be, if we find that the patient had been fre-
quently fubject to pains of the fmall inteftines, and to a flux of blood from
the hemorrhoidal veins; although it has been afterwards diminifh'd, or fup-
prefs'd •, if the tumour be affected with pain, when the inteftines are troubled
with flatus •, if the bowels have become more and more coftive, from the
time the tumour began •, and other things of the fame kind ; which are either
read in the hiftory I have given you, or may come into your mind from
reading it.
Yet thefe would be more peculiar marks, if the tumour fhould be obferv'd
by the patient, or by the phyficians, to be fometimes more confiderable •, and,
at other times, more flight ; harder or larger •, fofter or lefs •, as happens in
inteftinal hernias. And though it feems that this could happen very feldom,
in fuch a tumour as the bifhop's, by reafon of the very frequent flexures, the
confiderable conftriction, and the very clofe coalition, in particular, of one
inteftine with the other, being injurious to their periftaltic motion ; which
caufes, for inftance, obftruct and retain in them, as I have fee n, the matter
from whence the refiftance arifes ; yet it is natural to fuppofe, that if the en-
quiry be made accurately, and at repeated times ; and, particularly, when
either no excrements have been difcharg'd for fome time, or a great quantity
has been lately difcharg'd •, or when the patient is troubled with a large or
fmall quantity of flatus; it is natural to fuppofe, I fay, that fome one of
thefe figns may be in fome part found.
Thefe then are, in general, the remarks that came into my mind when I
was thinking of this tumour. Others will add different figns •, and you, in
confequence of your ingenuity, which is well-known to me, will add better.
And that you may do this the more eafily, I will fubjoin another obfervation
(although complicated with various diforders •, and perhaps not very ac-
curately defcrib'd, as I did not fee the patient myfelf ) which in fome mea-
fure relates to tumours of this kind ; but, at leaft, relates to the fubject of
this letter, and to the lower region of the belly, which, as the order I pro-
posal to myfelf requires, comes now to be confider'd.
29. A monk of the monaftery of St. Francefco, which is in the place of
my nativity, having fymptoms of a flight aicites, feem'd to have been fud-
(/) Epift. 10. n. 12. (m) Supra, n. 19.
4 denly
Letter XXXIX. Article 30. 395
denly emptied in the abdomen, by copious vomitings j except that'll) the hy-
pogaftrium, a tumour appear'd oJ fuch a hardnefe, as to make thofewho at-
tended hini iuppole it to be icinhous. When this tumour was comprels'd
with the hands, flatus was fore'd out bom below. The vomiting continued;
to which a conftant and incredible naulea being added, and an insuperable
coftivenefs, at length the inteftinal faxes, or, at leall, a matter very fimilar
thereto, began to be thrown up. Therefore, although no pain in the belly,
no figns or" inflammation had come on, the patient was, neverthelcfs, carried
off by the difeale.
While he was at the point of death, his phyfician, who was a man of emi-
nence, coming to me to beg of me to prcfide at the difl'eclion, on the day
following, if it were convenient for me •, and having related to me (who was
then confin'd to my bed with a flight fever) what I juft now told you, I laid
to him, I beg of you yourfelf to prefide-, for you can do it extremely well ;
and as you have inform'd me of the fymptoms which had preceded, I fhould
be glad to be inform'd, likewife, of the appearances you find : for what I
have heard from you of the afcites, the tumour, and the flatus being fore'd
out when it was prefs'd ; and, finally, of the ileos ; feem to me to argue a
cohefion, and fome entangled ftate, of the interlines. And on the following
day, which was the fixth of November in the year 1709, having very
obligingly return'd to me, he faid, in the following manner did we find the
appearances.
When the belly was open'd the interlines were found to be very livid, but
not putrified. The fmall inteftines, in a certain part of them, being fur-
prizingly entangled with each other, and join'd together by connexions
made up of a firm and denfe fubftance fimilar to a tendinous, and, indeed,
almoft fimilar to a cartilaginous fubftance, compos'd that tumour ; which was
render'd lb hard, not only on account of this interpos'd and connecting fub-
ftance, but alio on account of the fasces, with which they were fill'd, being
form'd into a kind of fmall globular bodies. Globules of this kind were not
only in that part, but alio in the neighbouring inteftine colon; till at length
it became impervious for fome extent, not long before it terminated in the
rectum ; in which tract, when we cut into it, we found it to be made up, not
of whitifh, but entirely of flefhy fibres. The ftomach was internally livid to
a fmall degree, and full of a fluid of the fame colour.
30. You fee that another phyfician, and an eminent man likewife, was
deceiv'd in the fame manner, and for the fame reafon. And his obfervation,
if it had been in my mind eighteen years after, as it was then remark'd,
might have been uleful, without doubt ; not only to determine the fitua-
tion of that tumour, which I have delcrib'd to you at large («), with fome-
what more confidence ; but alfo to conjecture the nature of it with much
greater juftice: although in the monk it was much lefs, and not fo promi-
nent, nor moveable, as far as I know, nor attended with any pain •, and the
difcharge of flatus from below had follow'd the preflure of it in the be-
ginning; whether the inteftine colon had not yet entirely coalefc'd, or whe-
ther the extreme circular part of it, which was kept open, lay under the tu-
(/;) Supra n. 19.
E e e 2 mour
396 Book III. Of the Difeafes of the Belly.
mour in fuch a manner, that when the tumour was comprefs'd this part was
comprefs'd alio.
To thefe were added other different circumftances ; in particular the hard-
nefs which lay betwixt the inteftines, and the foregoing dropfy of the afcitcs
kind : and from hence it was, join'd together with other tokens, that I fuf-
pected fome cohefion, as I have faid (0), of the inteftines. For, in the firft
place, I had feen, in the year 1699 ; when Valfalva open'd the abdomen of
a woman, who died of an afcites, in the hofpital of incurables at Bologna ;
the inteftines adhering, almoft every where, with the peritonaeum ; but par-
ticularly to one another, in a very great degree ; fo as to be almoft grown
into one fubftance-, being connected, in the greater part of them, by a kind
of cartilaginous fubftance ; which, in fome places, but chiefly about the colon,
was equal to an inch in thicknefs.
In the fecond place, I had read Ruyfch (p) taking notice of the inteftines,
in another woman, who died of the fame difeafe ; " not only as being grown,
" every where, to the peritonaeum, but to each other alfo." And I had
heard from Valfalva, that, in one who, like this monk, had laboured under
a foregoing dropfy, the inteftines were connected one with another •, as you
have it in the hiftory of a perfon that I have defcrib'd to you on a former oc-
cafion (q). And you will, likewife, find in another letter which I have fent
you (V), that in a man whofe belly contain'd a great quantity of water, I had
feen the inteftines already join'd to one another, by a kind of flaccid mem-
branes, as it were: and thefe, probably, were the firft beginnings of the co-
hefions •, which, when the water is difcharg'd, become more firm •, and con-
tinue afterwards, even when the water, as frequently happens, is collected
again : and I think I have fufficiently fhown you already (s)y what the mat-
ter is, from whence membranes of this kind have their origin.
In regard to this connection of the inteftines ; although I fee that men of
great eminence have the fame opinion which I have; I do not, however, think,
that they always cohere together in this manner •, but in different ways alfo ;
which I took notice of, when I wrote to you (/) upon the adhefion of the
lungs to the pleura, or of the heart to the pericardium. And, indeed, where
the coalition is brought about in confequence of inflammation only •, by which,
to ufe the words of Ruyfch (u), " we fee that the vifcera are often drawn
'.' together, and united to one another " there are different modes of ex-
plaining, and accounting for, the union ; that is to fay, whether you follow,
with moft others, thofe who confider the drynefs of the furfaces that are con-
tiguous to each other •, or thofe who attribute it chiefly to the vifcidity of
thefe furfaces, from an increas'd perfpiration of humours ; which, as they
might have added, the retarded motion of the blood renders more vifcid.
But as Crellius (x), that author whom we loft by an untimely death, has
receded from the firft, and even the fecond, mode of explication, not with-
out afligning a reafon for his diflention ; it is neceflary to attempt the ex-
(0) N. 29. (t) Epift. 16. n. 15; epift. 18. n. 15, ep.
(p) Obf. anat. chir. 45. 23. n. 17.
(q) Epift. 17. n. 17. ' (u) Obf. cit. 83.
(r) Epift. 10. n. 13. (x) Diflert. de vifcer. nexib. infolit. n. 14.
(/) Epift, 20. n. 37.
4 planation
Letter XXXIX. Article 3L 397
planation of this appearance in a different manner. But not to quit the fub-
ject of the droply, it is alio very taly to conceive; as the fame author has
acknowledg'd (y); how a coalition of the vifcera may happen in thatdifeafe,
if the water, in which they are macerated, be of a more acrid nature than
ulual, fo as (lightly to erode the furface of them. And what mult be the
confequence where it is purulent, as it was in one of the two obligations,
which I took notice of above (z), from the Sepulchrctum, wherein the in-
teftines were found to be drawn up to the upper parts ? And figns of erofion
were not wanting even in the other, in which the inteftines of a dropfical wo-
man were leen to be roll'd up into one heap, and made into a kind of glo-
bular figure. You lee then, by how many obiervations I was indue'd to
fufpect, that there might be fome cohefion of the inteftines ; when I heard
that, befides the other marks, there had been an afcites.
31. But as the inteftines may cohere with one another, and, without
leaving the fituations in which they are naturally plac'd, be heap'd up
together ; fo that, lying one over another, they may form a tumour, or
a kind of globe ; if you enquire after the caufes of this conglomerated
ftate; I do not know whether any one more probable can be thought of than
pains : by the force of which, the feats of the inteftines may be chang'd,
as well as cohefions be brought on. And that the fituations are fre-
quently chang'd, in thofe who are fubject to pains of the inteftines, is fhown,
in a former letter, from obfervations of bodies of this kind (a) : as when
the included flatus forces the diftended colon to fome other part of the ab-
domen, or difturbs it in its natural fituation : which caufe, if transfer'd to the
fmall inteftines, will help you to conceive, in what manner fome tracts thereof,
which are dilated, may raife themfelves up into that part, where they were
not before, and thruft to one fide, and even force beneath themfelves, thofe
tracts which naturally lay in that fituation.
Add to this the motions of thofe parts of the inteftines, which are tortur'd
with convulfive contractions, in confequence of pains : add the contractions
of this kind in the mefentery ; by which being crifp'd up, it may either draw
to itfelf fome of the anneje'd inteftines, or moft, or all of them ; and it will
appear much more clearly, how they may be fore'd together, into globes of
a fmaller or of a larger fize. And if they be retain'd in their new fituation,
for a confiderable time, by thefe caufes that are mention'd, and are prefs'd
one againft another ; it will appear, at the fame time, why they there begin
to cohere with each other, on account of the pains; efpecially if you confider
that many, and very vifcid, particles of humours, which ftagnate there, are
prefs'd out from their furfaces by the fame contractions : by means of which
particles ; particularly in bodies that abound with vifcidity ; the fame furfaces
may be join'd together, as if by a kind of gluten.
Nor, indeed, is it any new thing that the inteftines fliould be connected,
and conglutinated, in confequence of pains. For thus, not to lead you too
far from the Sepulchretum, in a woman who had been carried off by long-
continu'd tortures of thefe vifcera (£), they were found to be " connected
(_y) Ibid. n. 12. (a) Epift. 34. n. 4.
- (*) N. 28. (b) L. 3. fett. 14. obf. 16. %. 4.
41 to
398 Book III. Of Difeafes of the Belly.
" to each other, in many places •," and in another, who had died after " very
*• great, and incredible" pains of the belly (c)> the obfervator found " all
" the frrrall inteftines, which protuberated, connected very clofely with each
" other."
And if you underftand this word protuberated in fuch a fenfe, as to fignify
that they were heap'd up together, into one prominent globe ; and in the
fame manner that I have related above {d), from the obfervation of Fantonus •,
" roll'd up as it were into one globular body •" you will perceive that they
were found to be connected, and heap'd up together, at the fame time, in
confequence of pain, juft as they were found to be, by us, in the bifhop (e) :
although in thefe other obfervations, a peculiar, and externally circumfcrib'd,
tumour is not fpoken of; and in one of them, could not have exifted -, as in
that cafe a large quantity of bloody ferum, that had been extravafated, diftend-
ed the whole abdomen. And although the monk was not lb excruciated with
pains (/), as the bifhop was j yet I do not, for a certainty, know that he had
been free therefrom before.
32. But as to his not only having, like the bifhop, the inteftines conglu-
tinated, but connected, to one another by a kind of cartilaginous fubitance •,
this is neither furprizing to me, who have likewife feen the fame thing, in
conjunction with Valfalva, after an afcites ■, as I have already faid (g): nor
am I ignorant that the peritonaeum itfelf •, the production of which compofes
the external coat of the inteftines ; may become very thick in dropfical bodies;
and even " in procefs of time acquire a cartilaginous hardnefs-," according
to the obfervation of Paul Barbette (b) ; who puts us in mind of this, as
'** necefiary to be known in the paracentesis of the abdomen."
But that the inteftines are lbmetimes connected, by hard bands of this
kind, even without an afcites, we learn from the obfervation of Saporiti in
Valifneri (/). " We found," fays he, " the large inteftines, particular-
" ly where they are reflected, in the neighbourhood of the duodenum,
'* confolidated, by means of callous protuberances, with each other, and
" with the adjacent inteftines •, fo that it was difficult to diftinguilh the one
" from the other ; and what was worfe, their fubftance fo concreted, like a
" hardifh cartilage, and thicken'd, that fcarcely any cavity remain'd." A
fubftance, and contraction, of which kind, Ruyfch {k) found in the intef-
tinum rectum •, when he was oblig'd to divide it from the os lacrum, with an
iron wedge, and a wooden mallet.
But Benivenius (/) appears to have found the fame diforderof the inteftines,
after death, formerly, which he had been before fenfible of in the living
body ; when a kind of hard fubftance made a refiftance to his preiJure upon
the belly. And Donatus (m) produces another obfervation from Hollerius,
and Stalpart (n) different ones from different authors. And as in this author
(<?), examples are pointed out of the fame kind of coalition alfo ; and fuch as
(t) Se&. 21. obf. 41. . (/) Opera -torn. 3. p. 3.
(d) N. 28. \k) Obf anat. chir. 95.
• (e) Supra n. 26. (/) De abdit. morbor. &c. caufis c. 34.
(f) N. 29. (m) De medic, hilt. 1. 4. c. 10.
(g) N. 30. \n) Cent. 1. obf. 56.5c infchoJ.
(J>) Anat. praft. 1. 4. c. 2. (0) In eod. fchol.
might
Letter XXXIX. Article 31. 399
might be refer'd to that which I have laid was found at the extremity of the
colon in our monk-, and as other inltances air, moreover, extant in the Se-
pulchretum (/>); I will add nothing elfe, unlefs, that there was this peculia-
rity in- the monk •, I mean that, in the part jult now mention'd, the colon
feem'd to be made up entirely of flefhy fibres : which might be fuppos'd to
be the efte<ft of rednefs from a preceding ulcer. And it this fuppofition is
juft, then he could not have been without previous pains of the inteftines,
according to my conjecture.
But now let us come to tumours of the vilcera of a different kind.
33. A woman, feemingly, not much lets than forty years of age, had al-
ready labour'd, a year before, under a uterine haemorrhage. This was fuc-
peeded by a uterine fluor •, but of what colour, or fmell, is uncertain : this,
however, is certain, that it was attended with very fevere pains of the hy-
pogaftrium, and of the parts that lie beneath ; particularly in the night time ;
and with a tumour, into which alone (lie laid fome tubercles, that could
formerly be perceiv'd to be fcatter'd in the middle of the hypogattrium, had
coalelc'd. This tumour was now in that very fituation ; yet attended fo high
as to be fcarcely diftant from the navel by the breadth of two fingers ; being
wide in proportion, and fo prominent externally, that it was very apparent
to the eye, even at a diltar.ee ; wa? roundifh in its figure ; equal in its furface;
and, if you touch'd it, gave refiftance. .
A conftant dripping of urine had come on, a fpafmodic pain in the throat,
a naufea, and fometimes a vomiting-, a wafting offlefh, and a fever. With
all which diforders fhe was fo weaken'd, and broken down, about the begin-
ning of the year 1741; when fhe came into the hofpital at Padua; that fhe died
within fix or feven days : nobody doubting but fhe died of a cancerous tu-
mour of the uterus. And, indeed, a cancer had in part eroded the uterus -,
but the tumour did not belong to that, as I found by diffe&ion, and demon-
strated to a great circle of doctors and ftudents.
For when the belly was open'd, it immediately appear'd, that the bladder,
diftended with urine, had made up that great tumour; a circumftance which
nobody would have thought of-, her urine having continually run from her,
as I have faid. This receptacle had coalefc'd, on its anterior furface, high
above the pubes, with the parietes of the belly : and, if you except a consi-
derable fpace of the fame anterior furface, and of the upper part of the fun-
dus, it had all its remaining parietes compos'd of a hard and white fubftance,
of the thicknefs of a finger : as we faw plainly, after drawing out the urine ;
a great quantity of which it contain'd ; not in a lixivious ftate ; not thick ; not
of a difagreeable fmell ; but almoft watry.
The internal furface of the bladder was found, only diftinguifh'd, in fome
places, with fmall fanguiferous veffels, which were fcatter'd here and there -,
lb that the orifice of the bladder, at which part they are frequently very-
thick, was entirely without thefe veffels. On each fide of this orifice, within
the bladder, a white body was prominent, of an irregular figure ; equal in
fize to a man's thumb, and produe'd from the fubftance which furrounded
the urethra; which fubftance was here univerfally become thicker, hard, and
(p) L. 3. feft. 13.
white :
4oo Book III. Of Difeafes of the Belly.
white : and of this colour the urethra itfelf alfo was internally. Moreover,
the whole of that part of the ureter, which is carried betwixt the membranes
of the bladder, was more prominent than natural within the bladder, till it
terminated in an orifice much larger than the ufual one : this appearance
was on both fides, and both the ureters were univerfally dilated •, one of them
being full of urine, and the other almoft full of air. But even the tubuli of
the kidnies, and the pelvis on both fides, were dilated, though the kidnies
were in other refpects found.
Having examin'd the urinary organs, we look'd over the genital parts.
And, in the firft place, we found both the teftes, very clofely connected to the
parietes of the pelvis ; and both of them of a white colour : the left of which
was equal to the fize of a large chefnut, and the right to that of a fmall nut.
The latter of thefe contained a fmall quantity of water, perhaps within fome
kind of veficle ; being in other refpects white, as externally, and hard : but
the left had nothing under its coat, except a foft and white matter like
feet.
The uterus, however, if you confider'd the fundus of it, was externally
white, and fmooth •, and internally found in its parietes ; except that thefe
were more foft than they are naturally. But the external furface of the cer-
vix was unequally turgid on the back-part : and the cervix itfelf, and the
vagina, from the upper part almoft to the lower, were made up of very
thick, white, and hard parietes •, the internal furface of which, and the ofcu-
lum uteri itfelf, were eroded, and deftroy'd with deep, and diicolour'd ulcers.
For they were white in fome places \ of a black bloody colour in others, and
in fome cineritious. And from all of them a putrid matter, ting'd with thefe
colours, was eafily rub'd off with the handle of the knife; till we came to
the hard and white fubftance whereof I faid that the parietes confided ; into
which kind of fubftance, alfo, whatever is wont to be of a pinguedinous and
membranous nature, at the fides of the vagina, was converted.
But, although both the bladder, and the fubftance furrounding the
urethra, had been fo chang'd, as I have faid, on the anterior furface of the
cervix, and vagina •, yet the inteftinum rectum could be feparated from
the vagina •, which was, in other refpects, much more ulcerated than the
cervix uteri ; without being injur'd. And in the whole of this difiection, no
very dilagreeable fmell was perceiv'd. To infpect the other vilcera was not
necefiary ; nor, indeed, had we leifure. However, in the abdomen nothing,
befides thefe parts, appear'd to be evidently morbid ; though I obferv'd the
ftomach to be very much contracted •, and all the inteftines to be more con-
tracted than ufual alio : neither of which appearances is to be wonder'd at
here, in a woman who fcarcely took in any food by reafon of her naufeaj and
fometimes threw it up again, as 1 have faid, when it was taken in.
34. This obfervation may, in many refpects, be very ufeful by rendering
phyficians cautious. For who, after having heard that one tumour was made
up of tubercles which formerly lay at a diftance from each other ; and that
this tumour was join'd with marks of a uterine cancer ; whether he attended
to the prefent, or the foregoing fymptoms ; would not have thought that it
was a tumour of the uterus itfelf? Yet this tumour did not relate to the ute-
rus, but to the diftended bladder ; which, by forcing the neighbouring in-
teftines
Letter XXXIX. Article $5. 401
teftines upwards, while it began to raifc itfeff higher, and, by comprefiing
lome parts or' them, perhaps gave that appearance of divided tubercles.
Who, in like manner, that had been inform'd of the urine dripping away
from her conltantly, inltead of being retain'd, would have iufpected what
was really the cafe, that a great part of the urine, ncvcrthelcts, ftill remain'd
in the bladder, and, by the dextrous introduction of the catheter, might have
been drawn off, at leaft, in part, to the great alleviation of the miferable
patient ? For as to Ruyfch finding (q) that fullncis of bladder, at length, in
a lying-in woman, who likewife believ'd that fhe had no urine in her bladder,
notwithftanding it was diftended with a great quantity, in confequence of
being deceiv'd by a fimilar ftillicidium, as it feems; it is very certain that
there was not the leaft iign in that woman, of a difeas'd uterus, to which the
tumour of the belly could be reier'd. And, indeed, in another woman (r),
who had fome fymptoms of the uterus being pregnant with a foetus, no-
body rerer'd the tumour of the belly to any other part but the uterus, though
it was, in fact, made up of a large abfeefs, form'd betwixt the anterior coats
of the bladder.
When, therefore, there is a tumour of the hypogaftrium in women, al-
though marks of a difeas'd uterus may not be wanting, a fufpicion of the
bladder, which is fituated before the uterus, ought not, by any means, to be
intiivly pafs'd by : nor are we to take for granted, becaufe they fay that their
urine is continually running from them, that no part of it, for that realbn,
remains : nor, finally, although it is certain, that the vagina is ulcerated, to-
gether with the uterus, are we always to conclude, that the ftillicidium of
the urine is to be accounted for from the ulceration of the annex'd urethra
and bladder. For neither of them was ulcerated in this cafe. But, what is
an extraordinary inftance of caufe and effect , a fcirrhous hardnefs, of both of
them, brought on an incontinency of urine, and a retention at the fame
time.
For the hard parietes of the urethra could not be fo conftring'd, as pro-
perly to fliut up the orifice of the bladder. And the hard parietes of the
bladder, or, at leaft, the chief part of them, could not be fo contracted, as
the extrufion of the urine requires: nor could the remaining part of them,
which was not hard, fufficiently help forward this difcharge, in confequence
of its having coalefc'd with the anterior paries of the belly, almoft univer-
sally : and the difcharge was fomewhat impeded by thofe two thick bodies,
which were prominent at the fides of the orifice. On all of which accounts
it is not to be wonder'd at, if fo much urine was retain'd, as not only to fill
the enlarg'd bladder, but even to dilate the ureters, and the pelvis of both
kidnies, with their tubuli.
35. And having made nearly thefe remarks upon the urinary parts, to thofe
who were prefent, I then immediately added fome of thofe things, in regard
to the genitals, which I mall here fubjoin : that the uterus, together with its
appendages, was extremely fubject to fcirrhi •, a difeafe that is extremely dif-
ficult of cure, unlefs you foon find it out.; and incurable if it has degenerated
into a cancer. That I had heard one of my preceptors, I mean Albertini,
(g) Advert", anat. dec. 2. c. 9. (>•) Vid. Sepulchr. feci, hac 2i.obf. 23. in additam.
Vol. II. F f f fay
402 Book III. Of Difeafes of the Belly.
fay that he had, with great fuccefs, difcufs'd a tumour of the uterus, which
feem'd to him, when he examin'd it with his han.1, to be fcirrbous, by the
ufe of ground-pine alone, and without any excretion being the coniequence
thereof: that another of my preceptors, I mean Vallalva, was us'd to aflert
'in his medical opinions, that either for cancerous tumours of the uterus, or
of the breafts, he had found the practice of bleeding, four times a year, to
be the moil advantageous remedy to prevent their increafe ; that is to fay,
bleeding twice in the fpring, and twice in the autumn. But he faid it was
manifeft that, in the latter cafes, the ftrength was to be attended to-, and
agreeable to reafon, that, in the former, the cauies of the fcirrhus mould
be confider'd.
For although the ground-pine, by its attenuating and abfterfive quality,
takes away obftructions of the vilcera, and hardnefles of the breaft, accord-
ing to the obfervations of the ancients •, yet that I fliould not be willing to
give it to thole women who had been fubject to uterine fluxes, as the woman
was, whofe hiftory I have given ; but would very readily give it to thole,
who, by having matter tranflated to the uterus, from the joints which were
affedled with arthritic pains, had lately fallen into a flight obftruction there-
of; for it will excite the menftrual difcharges, but is oppofite to the caufe
of the gout, as you know.
Moreover, that the extenfions, the fpecies, the feats, and the origins,
of uterine fchirri differ much from one another. That this had been ex-
tended widely to the vagina alfo, and the parts annex'd to it ; and not only
laterally, but even on the anterior part •, that is in the urethra, and bladderT.
on the furface by which it was turn'd towards the uterus. That the whole
of it had confided of a uniform and hard fubftance •, and this of fuch a kind
that, even when turn'd into an ulcerated cancer, the odour of which is ge-
nerally extremely orTenfive, it had no difagreeable fmell. That the fituation
of this, in regard to the uterus itfelf, had been the whole cervix ; whereas,
there are thole, to which part of the cervix, or part of the fundus, or the
whole fundus, afford a fituation. Finally, that the origins of fome are in-
ternal, an,d of others external. And having laid thefe things in a brief man-
ner, and hinted flightly at thofe which relate to the fuet-like matter, found
in one of the teftes, I made an end of fpeaking.
36. But to you I will now explain, fomewhat more at large, the laft of
thofe remarks, which I then made with fo much brevity. I believe that I
have feen the origins, or firfl principles of uterine fcirrhi, more than once,
both internally, and externally. As to the internal, however, I fhall have a.
more convenient opportunity of fpeaking thereof hereafter (s) ; I fhall here
only mention the external.
On the external furface of the uterus, then, I have feen tubercles promi-
nent, being fix'd in the nearefl part of its fubftance •, at one time of a red co-
lour degenerating into livid, and at another time of a white colour, and a-
icirrhous hardneis ; as by reading over again my letters (7), or by examining
fome of them that I am so fend you hereafter (u), you will clearly per-
(s) Epift. 47. n. 26. & feq. (u) Ep. 56. n. :o.
(/) Ep. 38. n. z8. & ep. 37. n. 29.
ceiveT
Letter XXXIX. Article 36. 403
1 eivc. And I fuppofc thefe tubercles to be enlarg'd, and grow out into
fcirrnous tumours. For as to the puilulc which I have defcrib'd to you on
another occafion (x)t as being ken by me in the fame Gtuation, and the
Jittle bodies which Valfalva (aw fcatter d about (y)t and the tubercle lien by
Santorini (z) ; I do not doubt but they belong quite to another clafs •, inafmuch
as the luit-mention'd was of the fpecies ol encysted tumours, and the others
either had pus in them already, or becauie, as they had a limilar appearance
in other places, they would have had a pus afterwards, or a pultaceous matter.
For the uterus has, fomctimes, ulcers alio externally, and not thefe only,
but excrefcences likewife ; and in regard to thefe, you will read the defcrip-
tions of two very large ones in the Sepulehretum -(a) ; one of which confided
of a coat that was " like lard, or fuet ;" and the other was even " lill'd
" with fat." And thefe two I particularly point out ; becauie, in the fame
place (/>), a paflage of Severinus is quoted, wherein he confeflcs, " that on
" the external habit of the uterus, he had very often happen'd to meet with
" melicerides, and atheromata :" but at the fame time does not call to mind,
if I underltand him rightly, whether he had ever happen'd to fee " any" of
the fteatomatous kind in that part.
But, at leaft, in the fame feclion of the Sepulehretum, to omit the exam-
ple (c) of the greatly enlarg'd uterus, which " univerfally refembled a kind
" of cartilaginous fat ;" for this certainly belongs more to fcirrhi than to
fteatomata •, at leaft, I fay, " an abfeefs in the collum uteri, reiembling the
*' nature of a fteatoma," is mention'd from Ballonius (d) ; and Rhodius (e)
has exprefly mention'd " a fteatoma adhering to the fundus uteri;" and
Goetzius (f) defcribes another: and I have defcrib'd to you, in the preceding
letter (g), the very fubftance of the fundus uteri, as well as the teftes and
tubes, converted into a fuet-like matter; and it is not at all furprizing, thac
what happens internally, fhoyld alfo take place externally; provided the
febaceous particles, wherewith the blood abounds, be carried to the external
parts of the parietes uteri, as well as to the internal : although we have lefs
frequent examples of the uterus being affedled with a fteatoma, than of the
teftes.
Omitting, therefore, fuch as I do not fuppofe to relate to fcirrhi, I confider
the other difeafes, which I have taken notice of above, as their primordia,
and others of the fame kind, likewife, as, for inftance, that which is de-
fcrib'd by Paawius (h), as " a white excrefcence of the bignefs of a wart ;
which, when cut into, contain'd nothing within, but wasfolid in every part :"
and ftill more thofe defcrib'd by Ruyfch (/'J, under the appearance of " fmall
" round tumours, in a very fcirrhous ftate, or rather fcirrhi, not only grow-
" ing to the uterus, by the intervention of a peduncle, but even without it;"
which uterus was every-where befet with the fame kind of tumours, and
others of different magnitudes.
Thefe two examples you will add to as many others ; for Crellius has not
(r) Ep. 55. n. 16. (a) Ibid. §. n.
fyj Ep. 22. n. 18. (.•') Cent. 3. obf. 46.
(i) Ep. 19. n. 51. (f) Act. n. c. torn. z. obf. 207.
(a) Scft. hac 21. obf. ^4. §. 1. k 18. (g) N. 34.
{&) Ibid, fchol. ad obf. 37. (b) Sepulchr. feU. oit. obf. 4. §. 32.
Obf. cit. 54. §. 15. (1) Thef. 6. n. 30.
F f f 2 produe'd
4C4 Book III. Of Difea&s of the Belly.
produced any mofe, of this kind, in that Programma [k) ; wherein he, alfo^
has undertaken to defcribe a hard and iblid " tumour," of the bignefs of a
mulberry, " which adher'd, externally, to the fundus uteri." And I faid, of
this kind, for he has alfo made remarks on another kind •, as you may fee in
his works : and indeed bony tumours, or tumours in a manner bony, are
Lpoken of in the Commercium Litter avium (/).
Nor would obfervations be wanting, if the queftion were of them in this
place, of the uterus •, which either feem'd to be affected with a fcirrhous tu-
mour, on account of many Hones wherewith its fubflance was fturT'd up (m) -y
or was really fcirrhous, in one half of it («) ; or in the whole (o) ; fo as to be
equal to the weight of four and forty pounds: and hiftories of tumours
would be at hand, the fituations of which might eafily impofe upon the phy-
fician who examin'd them with his hand, fo as to make him take them for
fcirrhi of the uterus ; whereas they in fact had not the leaft reference to this ;
but either belong'd to the fundus of the bladder (/>), or to fome other neigh-
bouring part (q).
But not to digrefs from the difcourfe which I had begun, upon external
fcirrhous tubercles, and even to rinifh it ; if you fhould enquire, how it hap-
pens that fcirrhous tubercles may be, fometimes, found hanging, by a very-
narrow peduncle, from the uterus, as I have faid was feen by Ruyfch, or
from the other vifcera •, although this may be conceiv'd of in more ways than
one ; yet it will here be fufficient for me to recal to your mind that method
by which I have explain'd hydatids (that hang in the fame manner, and the
transformation of thefe into hard tubercles, after diicharging their fluid) in
the preceding letter (r) j for that the uterus has its hydatids alfo, is fuffkient-
ly demonftrated in the fame place (s).
For I mull:, here, pafs over, from tumours of the uterus, to tumours of
the ovaria : of which, however, I fhall fay lb much the lefs at prefent, as I
was under neceflity of faying fo much in the preceding letter : and to what
was there faid you may add what follows.
37. A woman, who feem*d to be about forty years of age, being opprefs'd
with a violent diforder within the thorax, was brought into the hoipital of St.
Mary de Morte at Bologna, about the end of April, in the year 1706; but
fo late in the difeafe, that, dying foon after, fhe could not even tell any one,
under what difagreeable fymptoms fhe had labour'd, through the courfe of
her difeafe.
Being about, therefore, to open her body, in order to examine, with ac-
curacy, into the flruclure of fome of the vifcera of the belly, and having
obferv'd two things ; that in a pretty laudable habit there was no appearance
of the breads, befides the areolae, and the nipples •, and that the abdomen
was mark'd with no furrows, or ruga;, fo that it appear'd fhe had never
born any children. ; I obferv'd, at the fame time, a certain tumour, not ac-.
(A) Vitembergx. a. 1739. (°) ^^- del' Acad. R. des fc. a> 1748.
(/) A. 1735. hebd. 51. n. 2. in fin. & a. ( p) Cit. eph. cent. i&2.obf. 1S6.
vj.\.z. hebd. 4.5. in fin. (q) Eph. earund. Dec. 3. a. 7. & 8. obf. 123.
(«/) Eph. n. c. cent. 1, & 2. obf. 77. (r) N. 38. in fin. & n, 35.
(«) Cent. 9. obi. 31. (1) N. 42.
5 cuminated.
Letter XXXIX. Article 38. 405
iinated, but flat-, which, in fome meafurc, rais'd up the hypogaftrium, and
that part of the umbilical region, which was nearcft thereto.
The belly, therefore, being open'd, I law that the cauie of the abdomen
being tumid in that part, was a certain body, of the bignefs of a very large
fill; by which the inteftines, that lay thereon, were driven upwards and out-
wards. This body was in the middle of the pelvis; ofaroundifh figure, and
of a tuberous furface ; but in fome places fmooth and even •, ^o as to make it
appear, at firft, that it could be nothing elfe but the uterus tumefied. Yet in
was, in fail, the left teftis, that had grown out into this bulk. The denfe
coat whereof was, here and there, unequal, with certain fmall abfeeffes ; fome
of which being IpontaneouJly open'd, difcharg'd a white pus ; fuch as many of
them contain'd.
From the body of the teftis itfelf, a thin bloody ichor was exprefs'd, mix'd
with pus ; yet not in great quantity. But when I had quite laid it open ; and
had agitated it for fome time in water; I plainly perceiv'd, befides fome fibres,,
and vcllels, and one or two cells, of the bignefs of a fmall grape, which com-
prehended,, within a black coat, lbmething very fimilar to coagulated blood; I
plainly perceiv'd, I fay, that the remaining, and much greater part, that is,,
almofl the whole folid part of this body, was nothing elfe but a congeries of
reddifh veficles, crouded clofely together, fo as to be of an incredible num-
ber, by reafon of their fmallnefs ; and all of them diflended with a dirty-co-
lour'd ferum.
Yet the fcetidnefs of the fmell was not very confiderable : nor was the
neighbouring tube injur'd, although externally, as well as the other, it had hy-
datids: nor had the uterus itfelf, to the fide of which the defcrib'd body was
annex'd, contracted any diforder therefrom, except in its external membrane.
For I cut through it ; and obferv'd only this one thing, which did not at all
relate to the tumour ; that, at the fides of this cavity, the anterior paries was
connected to the pofterior, by fmall membranes pafling betwixt. The other
teftis was fmall, unequal in its furface, and had only one veficle contiguous
to it, which was pretty large ; and contain'd a fmall quantity of fluid under
its thick white coat : in the other parts it was white and hard : yet from one
very fmall part of ir, was difcharg'd a little quantity of white pus.
38. Diforders of the teftes happen fo frequently to women, compar'd with
the females of other animals ; and eipecially tumours, either of a dropfical na-
ture, or of other kinds ; that it is very natural to conjecture moft of thefe
things to happen, not without the paflions of the mind being, in fame mea-
fure, the caufe of them. For what effect thefe paflions may have, in retard-
ing, or diflurbing,. the courfe of the humours, is by no means unknown.
Yet to this we may add the monthly afflux of blood into the uterus, and the
parts that lie about it; which we know frequently deviates from, the original
intention of nature, in many different ways. Add to thefe caufes alio, the
bulk and weight of the uterus, when impregnated ; by which, when the wo-
man ftands, or fits down, the teftes are prelVd clofely againft the bones of the
pelvis; and ftill more when it contracts fo very ftrongly in a difficult birth ;
or unfeafonably, in one which would certainly be eafy, and natural, if not-
accelerated by the improper hafte of midwives ; who are, for the moft part,,
unfkilful, For thefe, therefore, and other -reafons, it is not furprizing if the
teller
4o6 Book III. Of the Difeafcs of the Belly.
teftesof women arc frequently difeaVd, become tumid, and increas'd to fuch
a degree, that they very often refemble even an alcites •, as in that obferva-
tion, which was made in the fame hofpital at Bologna, by a very learned and
diligent man •, I mean Heraclito Manfredi ; who was with me, when I made
the former, and many others. I will communicate it to you, in the fame
manner that he communicated it to me, when I rcfided at Venice.
39. A woman, who had been fuppos'd to have an afcites, died. The belly
was not found to be fill'd with extravafated water ; but with a tumour of the
Jcft teflicle. This tumour weigh'd four and twenty pounds-, being fill'd, in
great meafure, with a vifcid and black humour ; which you might very wcii
compare with the dirty water, that flows through the channels, in the ftreejs
of a city. The other contents of the tumour were (hut up in veficles of un-
equal magnitudes, which communicated one with another •, fome of them
being fill'd with a yellow, fome with a vifcid matter, and others with a Ivmph,
which, when put on the fire, did not coagulate. Although it was connected
to no part, except the left fide of the uterus, yet it was quite immoveable, to
which-ever fide the body was turn'd •, becaufe, as it fix'd down a kind of lower
appendage of itfelf, which confuted of many hydatids, betwixt the uteru3
and the intcftine, it fo exaftly fill'd the inferior part of the pelvis, that while
it was drawn out from thence by force, a found was heard, fimilar to that
which is made by pulling away a cupping-glafs from the fkin.
40. In guefilng at the nature of other hidden difeafes, and particularly of
this, wemuftjoin together many marks, even for this reafon, that fome one
of them may happen to be abfent fometimes, as here. For among the figns
of this difeafe, fome mobility of the tumour is plac'd by Schorkopffius, in
the difiertation which he publiuVd at Bafil, in the year 1685, de Hydrope Ova-
rii Mtdiebris (t) \ a difiertation that merits more than ordinary praife-, efpeci-
ally when we confider the time wherein it was written \ even on account of the
obfervations of this difeafe, which he had receiv'd from that very great phyfi-
cian and anatomilt, Wepfer (») •, which I am not fo much furpriz'd mould be
unknown to Nuck (*), as that they were omitted in thole additamenta to the
Sepulchretum ; wherein (y) the words of Harderus, in which he exprefsly
commends this difiertation, and thofe obfervations, are copied.
However, in the firft times of the difeafe, perhaps, (which, as I faid in the
preceding letter (z), ought, for this reafon, to be attended to) there might,
probably, have been a mobility of the tumour, in the woman in queftion : as
there may, at the fame early times, alfo, be " a femicircular figure of the tu-
" mour," in the dropfy of the tube, according to the conjecture of Brecht-
feld (rf), which Schorkopffius (b) has follow'd •, in order to teach us by what
mark we may diftinguifli the dropfy of the ovarium, and the dropfy of the
tube, from each other : yet when the difeafe is advane'd, I do not doubt but
the tumour of a dropfy in the tube, no lefs than that of an aneurifm in the
artery, comes near to the oval, or fpherical figure •, which is confirm'd from
(t) Thef. 21.
(«) Thef. 16. 17. 23.
{x) Adenogr. c. 8.
(y) Schol. ad obf. 47.
(2) N. 60.
(a) Bartholin, aft. Hafn. vol. 1. p. 1. obf.
103.
(b) Thef. zz.
the
Letter XXXIX. Article 40. 407
the delineation given by Munnickius, of a droplical tube, to illuftrate thatob-
.cn of by mc in the fame letter (f).
But while I was attending to a number of hiltories or' tumours, of what-
t\ - r kind, in the tdr.es of women, it happes'd to come into my mind, that
this might, perhaps, be aoded to other marks thereof: I mean that it be-
gins in the left part of the hypogaftrium. For I obferv'd that the tumour
in the left teftis, and not in the rit>ht, which was feen by Manfrcdi (d) ■,
and that which was feen by me alio (c) j and not only thefe, but thole likewife
winch were feen by Kcrckringius (/), Wepfer (g), Harderus (£), Nuck (;'),
Drelincurt (/:), Reifelius (l)t Gahrlicpius (ttt)i the younger du Verney (»),
and this laft author in two cafes ; Rud. Jac. Camerarius (o)» Maggi and Do-
d\ (p), Ricdlinus (q), Scliacherus (rj, Alexander Camerarius (s), Gullman-
nus (/), Gutcermannus (/>), Bafllus (x)y Vacherius (y), Benevolus (z), Tar-
gioni {a). And, indeed, where there was a tumour of both the teites, the
largelt was found, by Hunerwolffius (b), in the left : nor do I forget that I
have defcrib'd to you hydatids, as being feen by me, within the left only(f)j
or much larger in this (d), than the other.
As I was attending to this very great content, in fuch a number of obfer-
vations •, and was already fo far fettled in the opinion, as to be much difpos'd to
account for the caufe of the difference, from the lefs expeditious return of the
blood, from the left teftis, to the vena cava •, as from thence it mull be brought
through a much longer paffage, than from the right •, I recollected that I had,
however, read not a few examples of tumours, which belong'd to the right
teftis. For Vefalius (e) had feen the right grown out into nine or ten large hy-
tids. And in the fame alio fince that, when it was diftended with ferum to
the quantity of nine pints ; an example " of the dropfy of the teftes" is pro-
posal by CafperBauhinf/J : who(g), with Hildanus (b), at another time, like-
wife, faw the right teftis of the magnitude of a goofe's egg, full of oblong
hairs, and a mucous matter.
Thefe hairs were alio found by Bkfius (i), together with other things, in
the teftis of the fame fide ; which was increas'd into a very great bulk. And
as there were others befides, whom I (hall mention below (k), that found hairs
in tumours of the teftes ; there were fome, as I fhall then fay, who faw
them in the left ; and yet as many who faw them in the right.
(<-) N. eg. (t) F.orund. t. 2. obf. 3o.
(W) N. 39. (») Eorund. t. 3. obf. 105.
(e) N. 37. (*) Dec. 4. obf. anat. 8.
(f) Spicileg. anat. obf. 10. (y) Hift. de l'acad. r. des fc. a. J739. obf.
(g) Apud ScorkopfF. th. 17. anat. 3.
(/j) Ibid. thef. 15. (z) Offervaz. 9.
(i) C. cir. (a) Prima Raccolta di effervazmed.
(i) Ibid. (b) Eph. n. c. dec. 2. a. 9. obf. 99.
(I) Eph. n. c. dec. 2. a. 10. obf. 27. (c) Epilh 15. n. 8.
(»*) Earund. dec. 3. a. 2. obf. 61. (d) Ep. 21. n. 47.
(«) Hift. de l'acad. r. des fc. a. 1703. (e) De corp. hum. fabr. 1. 5. c. 9.
(0) Biga. obf. med. c. 1. (f) Theatr. anat. 1. 1. c. 35.
(p) Apud Vallifner. iftor. della generaz. p. (g) Ibid.
3„c. 5. & tab 12. \i) Cent. 5. obf. 48.
(7) Eph. n. c. cent. 7. obf. 56. (0 Pa!t l.obl". njed. 9.
(r) Diiiert. de virg. afcitica. (i) IS 41.
(s) Act. n. c. tern. 1. obf. 160. verf. fin.
A tu-
40 8 Book III. Of Difeafes of the Belly.
A tumour of the fame teflis (not to detain you with a long detail) you will
find to have been leen by Chriftopher Harderus (7J; by Theodorus Zwin-
ger (m); by Lebenwalciius in) ; by Gandolphius (o) ; by Klaunigius (p) ; by
Jo. Dav. Mauchartus (q) ; by Miegius (r) •, by Alexander Camerarius (j) ; by
Trew(f); and even by our Mediavia j as I have written to you in a former
letter (u).
Nor, indeed, do I find any difference betwixt the tumours of the right,
and the left teftis, in one and the lame woman j whether defcrib'd by Heint-
zius formerly (x) ; or, afterwards, by Nabothus (y), and by Laubius (z) v
nor have I leen any in thofe which I have given the hiftories of, in the pre-
ceding letter (a) : or, if I find any difference, it is in the greater magnitude
of the right •, as in the obfervations of Bauhin (£)> of Gandolphius (c), and of
Goezz\us(d).
In the laft place: If the queftion be of hydatids, growing to the fubftance
of the teftis, Kerckringius (e) has obferv'd, that thole which he found, in an
infant, *' of the bignefs of a pigeon's egg," were not at the left, but upon
the right teftis. There were, without doubt, many more obfervations on
both fides : for I have only taken notice of thole which I at prelent call'd to
mind ; not fo much as you might perceive it to be the effect of meer chance,
that fo many obfervations occur'd to me at firft, and all of them taken from
the left fide, as that you might have a great number in readinefs, if, by com-
paring them one with another, you might be able to draw ufeful hints from
ibme, in order to conjecture at a hidden, and, at the fame time, frequent
difeafe.
41. Nor is what I laid of hairs being found, within the teftes of women,
by Bauhin, and Blafius, very extraordinary. For Bauhin (f) has propos'd
that oblervation in fuch a manner, as to hint that it was not the only one, nor
the firft : and, afterwards, both Blafius, as I have faid, and others, among
whom is Wepfer (g), and Andreas Veronicus (h), found the fame appear-
ance ; but thefe two on the left fide ; yet, on the right, were they found by
Stalpart (i), and the celebrated Haller (k): and not to add more, fome learned
men of Bologna obferv'd them once and again in the fame city, "and in my
memory-, and Menghinus, and Bonzius (/), lately, in the left teftis-, and
three and fifty years ago, he whom I fpoke of above (m), Manfredi, in the
right.
(/) Eph. n. c. dec. 1. a. 3. obf. 180. («) Eph. n. c. cent. 5. obi*. 21.
(m) Eamnd. dec. 2. a. 9. obf. 136. (a) N. 34.
(») Earund. dec. 3. a. 1. obf. 92. (£) Cit. c. 35.pi-i.mo loco.
(0) Hilt. del'Acad. R. des. fc. a. 1707. obf. (r) Cit. hi(t. priino loco,
anat. 4. (d) A&. n. c. torn. 1. obf. 207.
(/) Epb. n. c. cer.t. 7. obf. 64. (e) Obf. cit. io.
(<j) Earand. cent. 8. obf. 14. (f) C. cit. 35.
(r) Aft. n. c. torn. 1. obf. 85. (g) Vid. thef. 17. Schorkopffii cit. n. 40.
(j) Ibid. obf. 160. {h) ApudTargioni cit. ibid.
(/) Commerc. litter, a. 1734. hebd. 44. (j) Cent. 2. p. i. obf. 37.
(u) Epilt. 29. n. 14. (i) Opufc. pathol. obf. 42.
(x) Apud Schenck. obf. m?d. I. 3. ubi de (/) Comment, de Bonon. fc. acad. t. 2. p. I.
hydropeobf. 6. int;r medica.
(y) Diip.ii. de fceriiit. mulier n. 11. (ar) N. ,3.
For
Letter XXXIX. Article 42. 409
For he wrote to me that a globe of the bignefs of a very large egg, com-
prehended in a white, and almoll cartilaginous, coat, yet in fome places
pretty thin, and of a blackiih colour, was grown to the lubtlance of the right
tctlis : that within this globe had lain hid a quantity of hairs, in a conglo-
merated ftate, quite disjoin'd from that coat, and daub'd over with a kind of
fuet, as it were : that within the conglomerated hairs was a certain nucleus,
from which fome veiiels went into the continu'd fubftance of the teltis. Which
vefiels and nucleus I do not remember to have been obicrvM by others •, nor
yet the two circumftances which Bauhin had remark'd, that is to fay,
white hairs fix'd into the furrounding coat, but none at all on the pubes of
that woman ; although Ihe was by no means a girl, and had even brought
forth a child.
But while I was revifing this letter, I lit on a programma, entitled, de
Ovarii Tumore Pi/ofo, publiih'd at Leipfic, in the year 1735, by Polyc. Gottl.
Schacherus •, who not only mentions other obfervers of hairs, and of a fat
matter, in the teft.es of women, and efpecially on the right fide; but defcribes
the fame things, alio, as being found by him in the left teftis, which was
very confiderably enlarg'd : and, in particular, fays much on the fubject of
theie hairs ; and confirms, not only by words, but even by figures, that they
had come forth " from the internal furface of the incrafTated coat, which, for
that reafon, he does not fcruple to compare with the external hairy fkin of the
head. And indeed I have remark'd that hairs had been alfo feen by the cele-
brated Targioni (n), inherent, by one of their heads, in the thick and tena-
cious coat, juft as they generally are in the fkin. But from whatcaufe hairs
are form'd within the teftes, if they are really hairs, it is difficult to fay : and
yet not more than within other parts. For even Cornelius Celfus (<?), has
("aid, that in tumours of the thyroid gland, " hairs mix'd with fmall bones,"
are fometimes included : and others, quoted by the celebrated Heifter (p)y
have feen them in different places •, as I myfelf alfo have (q) within the tranf-
verle procefs of the dura mater.
But this letter is already very long ; fo that it rather becomes me, now, to
fee how I may conclude it with fome obfervation that fhall anfwer to that lad
of Valfalva's (r). This will be an obfervation, if not of the ftomach being
prolaps'd, at leaft of the fpleen •, and will be taken from the very friendly
letter of the fame Manfredi, whereby, in the year 1718, he communicated
this, as he did, in like manner, two others, which were by no means com-
mon obfervations.
42. There was a man, who had a fwelling of his belly, in the region of
each groin. But the left tumour, which was well-known to be a hernia, as
it had brought on death by caufing an ileos, gave us occafion to know what
the right was.
For the belly being open'd, the fpleen was found at the right groin, from
whence it could not be remov'd, although the body was much fhaken by taking
it out of the grave. This fpleen was about the weight of three pounds, of
the thicknefs of five inches, twelve in breadth, and as many in length. It was
(«) Cit. fupra ad n. 40. - (q) Epift. anat. 20. n. 58.
(0) De med. 1. 7. c. 13. (r) Supra n. 14.
(/) Epift. de pilis, &c. ad Paverum.
Vol. II. G g g com-
410 Book III. Of Difeafes of the Belly.
connected to' the ftomach, by a kind of rope which lay hid under a pare
of the interlines, being two inches in ihicknefs, made up of fan<>ui-
ferous veflels, and contain'd in a thickifh coat like a capfula ; fo that in co-
lour, and a certain contorfion of veflels, it was like the funis umbilicalis ;
although, externally, it had certain appendages, the remains perhaps of the
lacerated membranes, which, at firft fight, refembied thofe adipofe appendi-
cular, wherewith the large intestines are furnifh'd. The branches of the veins
that go to the fpleen v/ere extremely dilated : and that which is call'd the vas
breve eafily admitted the fore-finger.
43. Although Blafius (s), when he publiih'd the fame obfervation of a
prolaps'd fpleen, which Ruyfch (/) publiuYd afterwards, faid fomething
more than the other, of what had been obferv'd, both in the living body,
and after death 5 and among theie things, of " the fplenic veflels being in-
" creas'd to a furprizing degree, both in length, and capacity •/' yet I do
not remember to have read any author, who has defcrib'd the funis of the
fplenic veffels, in cafes of that kind, with more accuracy than Manfredi.
But, as to what relates to the caufes of this difeafe, I acknowledge, in-
deed, that the weight of the fpleen being increas'd, muft have had great
effect in relaxing, or breaking through, the membranous bands, which con-
nect it to the feptum tranfverfum •, and, indeed, moft of the obfervers have
cither mention'd, or hinted at, an increas'd weight, together with the pro-
lapfus. However, when I call to mind thofe enlarg'd fpleens, which had by
no means fallen down ; fuch as I have more than once defcrib'd to you («),
or fuch as you will read of in the Sepulchretum (x) ; I readily perceive that
fome other caufes ought to be added to that of weight, as, for inftance, the
greater laxity, or weaknefs, of thofe ligaments, a fall from a high place,
or other things of a fimilar kind •, among which confider whether you choofe
to place that which Riolanus (j) fuppos'd of the kidney. His words are
theie, " the caufeof a laxation of the kidney may be a violent, and long-con-
" tinu'd cough, which, perpetually agitating the diaphragm, may remove
" one or other of them from their fituation ■" that is, one or other of the
kidnies, which lie upon the diaphragm.
44. But by what figns this diforder may be known, and diftinguifh'd from
others, Is to be enquir*d from the hiftories thereof: although not all thofe
who found it in the dead body, could inform us how the patients had been
particularly affected, when living. For certainly thefe fymptoms are not pe-
culiar to a prolapfus of the fpleen, that we have in Ballonius (2), in an ex-
ample which is of ancient date, when compar'd with the others. Nor from
the obfervation of Cabrolius (a), which, perhaps, was not made long after
the former, can we gather any thing elfe, except that the fpleen could eafily
be perceiv'd, in the living, as well as in the dead body, " to fwim through
" the whole cavity of the belly." Which is a fign that, I believe, may not.
00 P. 1. obf. med. 14. (j) Anthropogr. !. 2. c. 26.
(/J Obf."anat. chir. 62. (z.) Epidem. 1. 2. vere a. 1578.
(u) Vid. prafertim epift. 36. n. II. & 17. (a) 6, in obf. var.
(*) L. 3. feft. 16. obf. 9. & feq. plurib. &
feft. 21. obf. 34. %. 1. 2. 3.
be
Letter XXXIX. Article 44. 411
he altogether without its advantage, but ought to be attended to, as I have
laid or others more than once, in the eailicll times of the dileife.
For in procefs of time it may eafily be wanting, in confequence ot' the
fpleen being become immoveable, as you have feen in the obfervation I have
given you from the letter of Manfredi ; and as you will fee in Ballonius : for
the fpleen lying upon the bladder, " adher'd thereto very clofely." This is
coniirm'd by Riolanus, where he fays, in his Encheiridion (b) ; that this dif-
order had been "four times feen" by him : and, certainly, in his An-
thropographia (c), he does produce two examples, in both of which the
fpleen had connected itfelf to the uterus, and the neighbouring parts, Co
firmly, that in one of them, it could no more be replac'd in its fituation as
before, while the woman was living •, and in the other it long impos'd upon
the phyficians by the appearance of a mola.
The fame author gives us thefe marks (</), whereby to diftinguifh it from a
prolaps'd kidney, " an oblong tumour, and an emptinefs of the left hypo-
" chondrium ;" the laft of which we muft enquire after in. the patient, when
failing ; and if we perceive it (which is eafy to do, in a patient in whom the
fpleen has been perceiv'd to be tumid before its prolapfus) we mall have a
much better mark to diftinguifh this prolaps'd (late of the fpleen, from any-
other hard tumour of the epigaftrium, than its figure; which, in difeas'd
parts, and particularly in this, as even Riolanus (e) himfelf teaches, we are
not ignorant may frequently and considerably vary.
But from the example of Blafius (f) we may gather two things ; one, that if
we mould chance to meet with what happen'd to him, as I fuppofe, for this
reafon •, becaufe the fpleen had fallen downwards gradually, the ligaments
being by degrees relax'd, and not fpeedily ruptur'd •, that is if we fhould hap-
pen, firft, to perceive a confiderable tumour occupying the left hypochon-
drium, with ibme part of the epigaftrium; and, after fome fpace of time,
find that it occupies the hypogaftrium, more than thofe parts ; we may then
be confirm'd in our conjecture : for otherwife, to attend to the place only, in
which we (hall at length perceive it, although it may be fometimes of'ufe in
our determination, that we feel it on the left fide ; yet in this method of
judging we may ibmetimes be deceived, as the obfervation of Manfredi (g)t
who found it at the right groin, demonferates.
The fecond conclusion which we may gather is, that, if the other figns
mow the tumour to arife from the prolaps'd fpleen, we are not, becaufe the tu-
mour fometimes retains its mobility, " beyond thefpace of fix months," which
Riolanus (b) had fix'd, fo as to change its fituation, on a change of fituation
in the body ; we are not, I fay, for this reafon to imagine, that the tumour
cannot be from a prolapfus of the fpleen. For although it is wont, at other
times, to adhere very eafily, as I have laid ; yet in the cafe of Blafius it was
pendulous even then, though the tumour had exifted " more than three
" years and a half;" and could even be variouily mov'd, according to the-
various agitation of the body. And from the fame cafe we learn, as it is re?
(b) L. 2. c. 26, (f) Obf. fupra ad n. 43. cit.
(c) L. 2. c. 23. (g) Supra, cod.
(d) Encheir. c. cit. (b) Encheir. c. ck,
(0 Ibid.
G g g 2 late^.
412 Book III-. Of Difeafes of the Belly.
lated by Ruyfch (/"), that this difeafe happens, fometimes, after a difficult
birth, and not without the moft violent pain : the former of which confirms
what we have added in regard to the caufes of the difeafe (k) ; and by the
latter we are admonihYd that we mull not fuppofe pain to be wanting in all
rhefe difeafes, and at every time of the difeale, becaufe the other hiftories
do not make mention of it.
The hiftory of Anthony de Pozzis (/) teaches us, that, notwithstanding an
enlarg'd fpleen, having chang'd its fituation by reafon of its weight, had oc-
cupied the hypogaftrium, for four-and-twenty years, the woman had liv'd
neverthelefs, had been three times pregnant in that fpace, and had brought
forth children that were healthy, and likely to live ; fo that we have lefs oc-
cafion to wonder that the other woman, fpoken of by Ballonius (m), did
once retain her foetus quite till the proper time of delivery ; though fhe,
at length, died in the birth. The obfervation of Drelincurt, given us by
Schorkopffius (»), confirms nothing at all, but that phyficians may eafily be
deceiv'd in this difeafe, by taking it for a utero-geftation.
Finally, the example of Bonetus (o) might go pretty far in proving
what I juft now faid of excruciating pains in the belly, if there had not been
another diforder befides, in the abdomen of that virgin. Nor do I remem-
ber, at prefent, to have heard, or read, more than thefe ten obfervations of
the fpleen being prolaps'd ; fo that Ruyfch (p) might, with reafon and juftice,
reckon " aprolapfus of the fpleen into the pelvis," among the cafes which
he had remark'd as the moft rare. Six of thefe obfervations relate to women,
two to men : but the remaining ones might relate to either one or the
other •, as Riolanus (q) has only hinted at, and not related, them, by faying
that unfkilful and incautious phyficians are deceiv'd in this manner, " by
" the appearance of a mole, or a fcirrhous uterus, in women ; and in men by
" the appearance of a glandular tumour, like a fteatoma, lying hid in the
" mefentery."
It has never yet happen'd to me, to meet with this appearance in diiTection,
though I have been very defirous, on feveral accounts, to enquire with ac-
curacy into many circumftances ; but particularly to enquire what then hap-
pens to the annex'd pancreas, ftomach, and the entire trunks of the fplenic
veffels. And there are indeed, in the obfervations which have been quoted',
efpecially in that of Ballonius, and Cabrolius, fome things which relate to
the ftomach. But as they might be from fome other caufe, and do not pro-
perly correfpond, in this part, with the hiftories of Pozzi, and Bonetus, I
have purpofely pafs'd them over.
45. I have, likewife, purpofely faid nothing of what was found by Hil-
danus (r), in the body of a woman ; as I read that the fpleen was very much
enlarg'd, and extended to the hypogaftrium indeed, but not prolaps'd thi-
ther ; as it has feem'd to men in other refpects very learn'd, in the mention
(j) made by Hildanus of the fame example, which they have fuppos'd to be
(/) Obf. 62. cit. ad n. 43. (0) Sepulchr. 1. 3. fett. 14. obf. 37.
(i) Eod. n. (p) Refp. ad Bidl. vindic.
(I) Eph. n. c. Dec. 1. a. 4. obf. 30. » (q) Encheir. c. cit.
(«) Loc. cit. (r) Cent. 2. obf. 45.
(») Diflert. fupra n. 40. cit. thef. 22. {J) Epift. 55.
anothe
r
Letter XXXIX. Article 46. 413
another obfervation. So I have confider'd, as a reference to, or commemora-
tion of, an obfervation formerly publilh'd (/), what Ruyfch has laid in his
Adverfaria (u) : for it is not furprizing if he, being a very old man, fhould
have written fome things in this reference, which do not altogether agree with
what he had (aid thirty years before-, fince even thofc tilings that he had then
written, that is twenty years after he had oblcrv'd them, do not fufficientlv
agree with what Blalius has recorded (.v), at the diftancc of no more than le-
ven years, from the time of making that obfervation ; Blafius, I fay, who
was both confulted by the woman when living, and prefent at the difiection,
which he lays was perform'd by Ruyfch on the twenty-fourth day of January
in the year 1670.
Ruyfch gives us the lame year, and fufficiently determines the time of
the year alio, when he lays that this very hiftory of his is related in the third
decade of Juftus Schradcrus, obfervation the fourth ; who lays, in this part of
his work, that Ruyfch had told him, on the thirty-firft of March, in the year
1670, that he had " lately" perform'd the diffection. But if an obfervation
of this kind were in the number of thofe, which might eafily happen twice,
to one anatomift, within two months, how came it to be rank'd among the
molt rare obfervations by Ruyfch (y) ? Yet Riolanus (2) faw it four times ; and
" twice," as I read while I am revifing this letter, the illuftrious Van Swieten
(a) faw, in dead bodies, " the fpleen in a fcirrhous and enlarg'd flate, and
*' fallen down quite to the pelvis," who I could wifh had been at leifure to
add the other circumilances that attended.
You will, however, take notice of thefe things : though it does not feem
improbable to me, that any one perfon may have met with a prolaps'd fpleen
more than once ; it does not, neverthelefs, feem very probable that any one
fhould have met with it twice, within the fpace of two months. Yet if you
fhould think that this word " lately" is taken, by me, in too fbricTt and con-
fin'd a fenfe ; although not by reafon of this circumftance alone, that firft ob-
fervation of Ruyfch has feem'd to me, by no means to agree very well with
the defcriptions of others, that were publifh'd before 5 I am not averfe to your
confidering the fecond as another, and numbering it with the reft, which
are taken notice of above (b).
46. Finally, what Riolanus (c) thought of the cure, in the firft times of the
difeafe, and what he did with this view ; and what he propos'd, or what he
forbad, in cafe of the fpleen being fix'd to the parts of the hypogaftrium ; you
will learn from himfelf. For I am not willing to make (till longer, a letter
which is already too long; the prolixity of which, though not to becompar'd
with that of the former letter, you will bear with the greater patience, when
you obferve, that I have, as I hate repetitions, almoft finifh'd therein, not
only whatever relates to the fection de Venlris Tumors, but alfo whatever be-
longs to the other de Hypogcftrii Dolore. Farewel.
(/) Cit. fupra ad n. 43, (a) Comment, in Boerh. aph. §. 958.
\u) Dec. 2. n. 9. (6) N. 44.
(x) Cit. fupra ad n. 43. (<-) Encheir. & Antrop. capitib. ad n. 44. cit.
(j) Vid. fupran. 43. fupra.
(z) Supra n. 44.
2 LETTER
414- Book III. Of Difeafes of the Belly.
LETTER the FORTIETH
Treats of Pain in the Loins.
WE are now come to diforders, the peculiar fituation and caufe of which
are frequently very obfcure •, that is to fay, to thofe which relate to
the urine, and urinary paflages. And this will appear even from the fub-
ject with which I begin •, I mean " the pain of the loins." For this fre-
quently relates to the kidnies being affecled with fandy particles, or cal-
culi : although that it does not lefs often, either relate to fome other part, or
.even to the kidnies themfelves, when affected from other caufes, you not only
very well know yourfelf, but will very clearly perceive alfo, from thofe ob-
fervations which I mail immediately defcribe to you, both from the papers of
Valfalva, and my own. For the firft of both of them will relate to the kid-
nies, and calculi •, and the latter to other diforders of the kidnies, or of other
parts. I will begin according to cuftom, as it is proper I mould, with thofe
of Valfalva that belong to the firft clafs.
2. A prieft of fifty years of age, having been many years fubject to arthri-
tic pains, efpecially of the fingers, was, at length, feiz'd with a nephritic pain.
There was not only a frequent vomiting of bilious matter, but once alfo of
blood, which had often been difcharg'd by the noftrils likewife. After that
his urine, from being in fmall quantity, and watery, began to be difch&rgVi
in a larger quantity, together with a mucilaginous and opaque matter : con-
vulfive motions of the whole body fuddenly came on ; and thefe returning
again, but in a more violent manner, carried him off.
The belly being open'd, all the inteflines were found to be of a colour in-
clining to livid. But the ftomach was found, and no traces appear'd of the place
from whence the blood had proceeded. In the kidnies lay feveral very fmall
calculi, fome black, others of a white colour •, and befides thefe there were
finuous cavities full of urine, but particularly in the right : the urine, alfo,
by its quantity, had dilated the pelvis, and the ureter, which was continu'd
therefrom.
In the head, the internal fubftance of the brain was, in fome meafure, preg-
nant with ferum ; but the ventricles of the brain particularly abounded there-
with.
Finally, at the joints of the fingers, when the cutis was taken off, a tarta-
reous matter was immediately found, in the membrane involving the tendons ;
and this matter was of a white colour inclining to yellow.
3. We may not only make many deductions from this obfervation (a me-
thod which will be often follow'd in this letter and others) but we may, in
1 parti-
Letter XL. Artiele 4. 415
particular, confirm that which often occurs in the practice of medicine ; I
mean, that to pains of the joints, arc often added pains of the kidnies j and
at length to the latter, very violent difordcrs of the brain. That is to fay,
they who are fubjeCf. to the gout, as they can ufe motion of the body leis in
proportion, fo they proportionably left agitate thole mufcles, by whole mo-
tions the contiguous kidnies may alio be agitated •, foas to prevent the urine
from ftagn a ting therein, and depofiting the fandy particfes, wherewith it is
loaded. Turn to Boerhaa've (a), and his illuitrious pupil Mailer (/;), who
rightly interprets the ideas of his mailer, and illufhatcs them. See, alio,
the observation of Littre (c) on a boy, who having a phimofis that previ
his urine from being properly difcharg'd, this fluid, for that reafon, ftagnated
betwixt the glands andjthe prepuce, and producM an incredible number of
lmall (tones ; none of which was any more produced, after the phimolis was
remov'd.
But as, when a calculus is already form'd in the kidnies, an obftacle fre-
quently happens, from thence, to the urine, and lefs fuperfiuous ferum is, for
that reafon, difcharg'd from the conilitution ; fo this ferum may be re-
dundant in the brain : or even the roughnefs of the calculus, by very vehe-
mently irritating the kidnies, may fometimes excite convulfions in the whole
body ; and, therefore, in the brain, as well as in other parts. However, by
which method you choofe to explain the convulfive motions, in the prieft in
quettion, or even death itfelf, I leave entirely to your own difcretion : al-
though the difcharge of a mucilaginous matter, from the urinary paffages,
which was fucceeded by the convulfions and death, feems to give great
countenance to the fecond fuppofition.
That is to fay, this mucilaginous humour, with which the pelvis, and the
tubuli belonging thereto, that receive the papillae of the kidnies, are, like
the bladder and ureters (inafmuch as they are made up of the fame continu'd
coat) fmear'd over internally, in order to defend them againft the acrimony
of the urine-, this humour then being increas'd, and become thicker, from
the irritation of the calculus, diminifhes the force of that irritation, as long
as it adheres to the calculus, and interpofes itfelf betwixt the rough furfaces
thereof, and this internal irritable coat. But when this mucilaginous hu-
mour has left the coat without defence, in confequence of being fore'd
down, by medicines improperly given to increafe the urinary difcharges •, or
from any other caufe whatever •, it muff, then, of courfe, follow, that the ir-
ritations are more violent. But you will, in my opinion, choofe rather
to make ufe of the firft explication, in the hiflory which I fhall next fub-
join.
4. A man about fixty years of age, of a very fat habit of body, who-,
while he was a young man, had been troubled with great difficulty in mak-
ing water ; fo as to be obligTd to ftand on tip-toe, fometimes, to difcharge it ■■,
had his urine wholly fupprefs'd, together with a very violent pain in the loins,
but without any vomiting. He had, every day, a very confiderable fever,
the rigor and coldnefs lafting for two hours. When the catheter was intro-
(a) Praeleft. ad §. 352. inftit. & ad §. 365. (c) Hill, ad l'Acad, R. des fc. a. 1706. obf.
(6) Not. e ad primum. St d ad alter, cit. an at. 6,
Boerhaav. locum.
due'd
4i 6 Book III. Of Difeafes of the Belly.
ducM he difcharg'd a bloody matter, and with it a calculus of the bignefs of
a fmall almond. This was flicceeded by bloody urine. But afterwards, the
urine grew clear, and became like that of healthy perfons •, yet was not with-
out a foetid fmell : and the pain in the loins always continu'd. The difeafe
having apparently remitted, as I have laid, the patient was feiz'd, on the
night of the fifth day, with a kind of epileptic concufiion, as it were, of the
whole body, attended with a bloody foam at the mouth ; and in this man-
ner departed out of life.
The belly being laid open, the bladder appear'd to be full of urine, which
was in a natural ftate, except that it had a very ill fmell. The flefhy fibres
of the bladder were become much thicken'd, fo as to refcmble the bundles
of muicular fibres in the heart. About the cervix t.Vsreof, were found fome
grains of land. However, there was no obftacle found in the bladder, where-
by the difcharge of the urine could be prevented. The ureters and the kid-
nies were perfectly found.
In the thorax, the lungs were turgid, and ting'd of a black colour: but
the left lobe adher'd clofely to the diaphragm. The right ventricle of the
heart contain'd a polypous concretion •, the left was full of a fluid blood.
5. Whatever had been, formerly, the caufe of that difficulty in making
water, from whence it is probable, as will be demonftrated on a future occa-
fion (*/), that the thicknefs of the fibres of the bladder was brought on •, the
laft difeafe, that relates to the urinary parts, feems to have been the effect of
the calculus. For this might be fo much the more eafily generated, in one
or other of the kidnies, as the weight of fat, in a very bulky man, render'd
exercife of body lefs eafy (e). To this method, by which Boerhaave (f) fup-
pos'd a ftone to have been form'd, in one of the kidnies of a very fat man
likewife (for both of thefe viicera are not always equally difpos'd to this con-
cretion) you may alfo add another-, which, with the fame author (g), you will
attribute to a quantity of fat, preffing upon the kidney, and the ureter ; and,
for that reafon, retarding the courfe of the urine, juft as the want of exercife
retards it.
Indeed, in thofe perfons who eat very plentifully, and very often, and
have their ftomachs, and inteflines, for that reafon, generally diftended with
too great a quantity of ingefta ; to the other caufes, whereby they become
fubject to calculi of the kidnies, add this in conjunction with me, that the
kidnies, and particularly the left, and both the ureters; inafmuch as they are
fituated betwixt the pofterior paries of the belly, and thofe vifcera; are more
than properly comprefs'd. And this caufe being added to thofe other caufes, in
the gentleman whom Scroeckius (h) defcribes, it is fo much the lefs to be
wonder'd at, that in one ureter was found a calculus of a considerable fize -,
and in the oppofite ureter, a very large one, withfo many fmaller calculi. But
the compreffion, either from a quantity of fat, or ingefta, is fo much the
more noxious in very bulky conftitutions, becaufe they generally lie on their
backs: which fituation of body lays both the kidnies, and the ureters, under
a ncceflity of being more comprefs'd, by the incumbent weight of vif-
(d) Epift. 42. n. 33. (g) Ad §. 387.
(s) Vid. fupra n. 3. [o) Aft. n. c. torn. 1. obf. 247.
(f) Ad §. 365. ibid. cit.
cera ;
Letter XL. Article 5. 417
cera •, and the rnore frequent-, and long-continued, this pofture of bcnly is,
fo much the more is the defcent of the urine prevailed.
Thus likewife, when you read a certain obfervation of the celebrated Fan-
tonus (/'), on a man fubjccl: to nephritic pains, efpecially in the left ['uk, and
whofe left kidney, which was twice as thick as it naturally is, and contain'd two
calculi, was cover'd over " with a certain concreted matter, limilar to lard, in
" one part as thick as ones little finger is broad, and, in another, thicker
" than a man's thumb-," which, however, did not cover the other kidney v
you will, without doubt, readily fuppofe the fat to have been injurious in
that cafe. In our man therefore, to whom I now return, the calculus, which
was already generated, might bring on both the pain or the loins, and the
fuppreffion of urine-, either by ihutting up the upper part of the ureter, or
the beginning; of the urethra.
For although it does not always happen, yet frequently it does at lea ft,
that when one kidney is affected, the other is alio drawn into conient. And
when the calculus was remov'd, by the force of the incumbent urine, and
thruft down into the lower orifice of the bladder, the pain of the loins might
continue, neverthelefs, in the fame manner that the pain of the kidnics is,
fometimes, wont to be extended towards the bladder ; that is to fay, by
means of the ureters, which are, on one hand, continued to the kidnies, and,
on the other, to the bladder : and, when the bladder can admit no more
urine, are themfelves diftended therewith. And though this urine fhould
be drawn off, by the introduction of a catheter, yet how foon it would fill
the bladder again, the infpeftion of this bladder, after the death of the pa-
tient, demonstrates.
But if you imagine that, becaufe the ureters feem'd found, no calculus,
except a very fmall one, had pervaded them, and they had not been diftended
with urine •, although not only the calculus was fmall, but the diftention of
fhort continuance ; yet you may eafily conceive of their being affected, by the
calculus fo far irritating the upper part of the urethra, into which it had been
thruft, that the blood, in the firft place, afterwards pus, and, laft of all
the ill fmell, with which the urine was infected, feem to have been owing
thereto •, fince we are not at liberty to fuppofe the blood, or the pus, to have
been difcharg'd from any other part but the urethra, though we do not read
of its having been laid open.
Nor do we read that the brain was examin'd, into which it is to be fup-
pos'd that, upon the fuppreffion of urine, the impure ferum had been dif-
charg'd from the blood •, and, being grown acrid by a fhort delay, had
brought on that epileptic concuffion and death, juft as it did, in my opinion,
in the two perfons, whofe hiftories you have in the twenty fecond fedtion of
the Sepulchretum (k) ; which you fee I here follow ; and who died, in like
manner, from ftones of the kidnies, and a fuppreffion of urine, not with-
out convulfions •, to omit many other examples of an apoplexy itfelf being
brought on by a fuppreffion of urine, and particularly that of Koenigius (/),
in a fenator whofe ureters were obftructed with calculi, and whofe kidnies,
(/) De obf. med. & anat. epiil. 8. n. 14. (I) Lithogenef. human, fpecim. epift. 2.
(k) L. 3. obf. 2.&obf. 13. §. 1.
Vol. II. H h h but
4i 8 Book III. Of the Difeafcs of the Belly.
but the right in particular, were much enlarg'd beyond their natural fize,
and contain'd a great quantity of fmall frones adhering to feveral parts •, their
coats being dilated, and tumid widi a great quantity or* ierum.
6. As it has been juft mown that a pain may be propagated from the blad-
der to the loins, it would be proper to add, on this occafion, other obferva-
tions of Valfalva's, which jointly demonftrate the fame thing to have proceed-
ed from fome other caufe ; if it did not ieem necelTary to mow, before we
quit the fubjecT: of the kidnies, that the pain of thefe parts, and confequently
of the loins, is fometimes to be imputed to a caufe which lies in the kidnies,
indeed, but is not a calculus. A very extraordinary, but not incredible caufe,
is that of worms, which have been found, not only in the kidnies of dogs, but
in thofe of men alfo, by many whom Dominicus de Marinis (m) fpeaks of by
name.-, to whom, being in great part taken notice of in the Sepulchretum
alfo (»), you may add lome others refer'd to in the fame book (o) ; and thofe,
befides, that are written of by Vallifneri (/>), or by Alghifi (q) to Vallifneri,
but particularly after Redi, Vallifneri himfelf, and Charles Drelincurt (r).
Yet, out of all the obfervers, you will read of very few, and thefe fuch as
were not, generally, very cautious in obferving, who aflert that they had
feen them within the kidnies even of human bodies ; fo that if we did not
know that they have certainly been found in dogs, and ferrets or weafels,
we mould, perhaps, in part call their obfervations into queftion, and in part
explain them differently ; upon calling to mind that oblong and round poly-
pus, which was difcharg'd from the urethra, after nephritic pains, and had,
at firft, impos'd upon Sponius (j), by the appearance of a worm. In pro-
portion, therefore, as the number of certain obfervations is more increas'd in
dogs, it becomes ftill fo much the more credible, that the fame thing may
happen in men alfo. With this view I (hall defcribe what was feen by Val-
falva, much in the fame manner as happen'd to the illuftrious Van Swieten
(0 alfo.
7. Valfalva had open'd a dog, for the fake of anatomical experiment,
when inflead of the right kidney, he found a body which, externally indeed,
was very much fimilar to the kidney, but had a thin glandular cortex be-
neath the external membrane ; to which fome fanguiferous vefiels were
carried ; and under this cortex a cavity, inverted with a very fmooth mem-
brane, piere'd through with many foramina, which went to this cortex ; fo
that the urine feem'd to flow from thence, through thefe foramina, into the
cavity. In this cavity lay a worm about three ells long, and of the thicknefs
of one of the largell quills which we ufe for writing.
8. Redi («), indeed, found worms in the kidney, that were thicker than
this, but not equally long. Kerckringius (x) and I have found them of an
ell in length, Vallifneri (y) four fpans, and Drelincurt longer than two feet •,
fo that for the length of an animal, which was not very thick, to be equal
(m) Di/Tert. de re monflr, a Capuc. & est. (1) Act. erud. Lipf. a. 1684. m. jun.
(«) Sect, hac 22. obf. 23. §. 5. & in fchol. (t) Com. in Boerhaav. aph. §. 1 134.
(0) Ibid. &in additam. ad cand. feci. obf. 2. (a) Oflervaz. int. agli anim. viv. & cxt.
(/>) Confideraz. int. alia generaz. de'Vermi. (x) Spicileg. anat. obf. 59.
(q) Opera del Vallifn. torn. i.p. 5. (j) Confider. cit.
(r) Experim. anat. canicid. 3. n. 10. & 16.
&canicid. 11. n. 36.
to
Letter XL. Article 8. 419
to about three ells, may feem very furprizing, unlets it be much increas'd
after death •, as I have obferv'd to happen in another fpecies or' worms (a) ;
and as Redi has obferv'd may eaiily happen in this; or uplefs, as you have it
in Drelincurt (3), there were two, and one had its roftrum or lnout very
clolely tix'd about the tail of the other.
For there are two in one kidney, ibmetimes, of unequal length indeed
(7), as Redi has alio obferv'd (d) ; but they are reprcfented of an equal length
by Blafius (*■), and thefe from an emaciated man : of which kind we read in
Zacutus (f) that another was, in whole kidnics worms, of a white colour,
are laid to have been, but very confiderably fhorter; whereas they were red
in the oblcrvation of Blafius ; which is the fame colour that they have been
always leen to be of in dogs, both by Redi, and Drelincurt : the former of
whom Ibmetimes found them alive, the latter always dead ; the one only in
males, and on the right fide, the other in a woman alio, and on the left
fide. Zacutus has laid that there were very fevere pains in the loins : which
Kerckrmgius, and Boirelius (g) teftify even to have been fignified in dogs,
by a perpetual howling ; whereas the others, whom I have mention'd by-
name, fay nothing of it.
As to what remains in refpect to the origin of thefe worms ; as, for inftance,
whether thofe in dogs are of that redifh kind which I have defcrib'd formerly
(/>), as being Ibmetimes found in certain tubercles, not far from the kidnies,
and which have Ibmetimes pafs'd over into the kidnies, after the tubercles
were eroded ; in fo great an inequality of length it is not eafy for me to de-
termine, unlefs 1 were, previoufly, more certainly inform'd of the ftructure
of each. Blafius, indeed, has defcrib'd, and reprefented in a figure, the
renal worms found by him, as confifting " of a great number of fmall rings,
" curioufly join'd together ;" but I fhould fuppofe that the engraver had
added a double head, and eyes, to that picture, from his own imagination.
Vallifneri oblerves that the one he law was not of the broad-worm fpecies,
as it was rather round ; but yet that it was not of any different kind, which
other authors, as far as he knew, had ever found to be contain'd within the
inteftines.
This remark of Vallifneri renders the account of their ftructure, given us
by Redi, very doubtful ; inafmuch as he reprefents it to be almoft in com-
mon with the round worms of the inteftines, as defcrib'd by this very author
himfelf ; to pafs by thofe circumftances, which Vallifneri (/) has remark'd to
differ entirely from this delcription. But though all the circumftances, re-
lating to renal worms, fhould be pretty certain and conftant, yet the fmall-
nefs of thofe which are in thefe tubercles of dogs, would render the necef-
fary companion of their internal ftructure very difficult. Leaving this la-
bour, however, to others who have more leifure upon their hands than I have,
I go on, in the mean while, as I have promis'd, to other hiftories of Valfalva,
(«) Epift. anat. 14. n. 47. (f) Sepulchr. feft. hac. 23. obf. 23. §. 5.
(b) Canicid. cit. 3. n. 16. (g) In additam. ad eand. feft. obf. 2.
(c) Ibid. n. 11. (Jo) Epift. anat. 9. n. 44. & feq.
(d) Oftervaz. cit. (/) Migliorajnenti d'alcune offervaz. del.
{/) P. 6. obf. med. 1 2. tab. 9. fig. 6 & 7. Redi n. 1 3.
H h h 2 wherein
420 Book III. Of Difeafes of the Belly.
wherein he has obferv'd the pain of the loins from caufes fituated on the out-
fide of the kidnies.
9. A virgin, of about four and twenty years of age, falling from a high
place, was i'c-iz'd with an opprefiive pain in her loins, and a fever. Both of
thefe fymptoms grew fomewhat mild. But both of them grew violent again
after fomt ays ; a fenfe of weight in the cavity of the abdomen being alio
added ; together with a vomiting of a matter fometimes green, and fomctimes
blackifli •, the fame being dilcharg'd downwards by (tool ; and in this manner
me died.
While the belly was open'd a fanies. immediately fiow'd out, which being
collected in fponges, weigh'd, when put all together, about eight pounds.
The inteftines were connected, one to another, by the external coat, yet in
fuch a manner that a pretty thick fanies lay hid in their interfaces. How-
ever, the inteftines themfelves, and the ftomach, fliow'd no diforder inter-
nally. The liver was whitifh, and had a very thick famous matter adhering
to it externally. But the omentum being annex'd to the peritonaeum on the
left fide, towards the iliac region, difcover'd an ulcer in that part.
10. Whatever the reafon was, why the internal paries of the belly, to-
wards the iliac region, was hurt by that fall, there, without doubt, fo large
an abfeefs was generated, as to difcharge this great quantity of fanies. When
pus is form'd, that happens which we learn from the aphorifm of Hippo-
crates (k) •, I mean that "pains and fevers" naturally become fomewhat
milder. But the frefh exacerbation of thefe fymptoms fignified the rupture
of the abfeefs ; as the effufion of pus into the cavity of the belly was mown
by the fenfe of weight in that cavity. But you will not enquire after the
caufe of pain in the loins, when you call to mind the feat of the abfeefs ; as
it was in that part of the abdomen, which verg'd to "the iliac region ; for the
fibres of the tranfverfe mufcles, which are in this very part, take their origin,
as you very well know, from the vertebrae of the loins : and that pains
fliould be felt at the extremities of the mufcles (efpecially when they are tied
very ftrongly to the bone) when their fibres fuffer detraction, and erofion,
need not be any great matter of furprize.
1 1 . Being about to add, in this place, other obfervations of Valfalva, of
pains raging in the fame place, even from a caufe plac'd on the outfide of the
belly and abdomen, it comes into my mind, that I have already defcrib'd
them to you, in a former letter (I) \ and that from the connexion of the ap-
pendages of the diaphragm, the action of a caufe, which lay hid in the
thorax, I mean its action upon thefe appendages, was explain'd : to which
clafs alio, perhaps the obfervation of Jacotius, that is to be met with in one
of the following lections of the Sepulchretum (m), belongs. And if a caufe
that lies on the outfide of the cavity of the belly, is able to do. this; how
much more will thofe, which lie either in the loins themfelves, or in fome
part of the belly that lies near to the loins, or is connected to them, be able
to effect the fame ?
You will fee thefe caufes particularly and fully recounted, in the Encheiri-
dion of Riolanus, in that chapter from whence they are transfer'd into this
(&) 47. fe&. II. (/) Epift. 16. n. 40 & 41. («) 25 obf. 14.
twenty-
Letter XL. Article 12. 421
twenty-fecond fecYion of the Sepulchre turn, in the fcholia to the firft obfer-
varion which is mark'd with the number thirty-eight •, for the lame number
is through careleffnds repeated : and you will fee molt or* them COnfirrh'd, in
the fame lection, by examples; as troiii a rhcumatiim oi" the loins, in obfer-
vation the twenty-ninth j from ferum in the tube of the lumbar vertebrae,
in obfervation the thirty-third: from the erofion of thefe vertebrae, in obfer-
vation the thirty-fifth, and fortieth : from 1 mall Hones, or if you choofe ra-
ther to have it lb, from fm'all bones in the lumbar arteries, in obfervation the
thirty-firft : from diforders of the mefentery, in the lecond thirty-eighth ob-
fervation, the thirty-ninth, and forty-tirlt, article the firft, fecond, fifth,
fixth, and ninth, and obfervation the firft in the additamenta : from diforders
of the uterus, in obfervation the forty-firit, article the fourth : from an ul-
cerated fcirrhus of the inteftinum ileum, in obiervation the thirty-fecond :
and, to omit others at preient, irom diforders of the pancreas, in obfervation
the twenty-fifth, and the fecond thirty-eighth, and in the forty-firft, article
the third : and I mould likewife add article the feventh, if it were not the
fame ; as article the fixth and eighth are the fame with thofe obfervations that
are juft now refer'd to •, the twenty-fifth, and thirty-eighth ; which are here
repeated through forgetfulnefs. And the pancreas not only affedb the neigh-
bouring vertebras, even of itfelf, but more frequently than many phyficians-
imagine •, as is rightly obferv'd by Francifcus Sylvius (;?) ; by the juice which it
then fends, in a preternatural ftate, as the liver does alio, into the duodenum,
that lies in contact with, and connected to, the fame vertebras, and the right
kidney •, from whence arifes a various fenie of pain in many of thefe vertebras,,
but particularly a fenfe of burning pain ; which is frequently imputed to the
kidnies, without any caufe.
But we mull now return to the kidnies themfelves, and firft as being af-
fected with calculi, if you are willing I fhould communicate to you my own
obfervations, in the fame order I have communicated Valfalva's, according to
my promife : altho' as thofe which are more remarkable, are to be defer'd to
other letters, for certain reafons, as you will then fee, I fhall here fubjoin one
only ; which, though deficient in the hiftory of the peculiar fymptoms that
had preceded, is not altogether without its utility neverthelefs.
12. A woman had died in the hofpital at Padua, when fhe was already
in the feventh month of her pregnancy ; it being then the month of March in
the year 1708.
The belly therefore, and the uterus, were immediately open'd after death,
and the foetus taken out alive, though it died foon after; at which time,
happening to be at Padua, 1 took the cervix of the uterus, which was even
then found, and the kidnies, in order to make fome accurate obfervations
upon them. It is to little purpoie to take notice here at large, of a quantity
of mucus within the cervix uteri, and of veficles which were pregnant there-
with, very confpicuous both in number and magnitude, that cover'd the fur-
face of the os uteri. But the kidnies deferve to be defcrib'd.
For the left, being larger than the magnitude of body required, fhow its
fmall canals to be thicker than they generally are ; and, for that reafon,.
(n) Vid. extrema fcholia ad cit. obf. 38. priraara,
5 very
422 Book III. Of Difeafea of the Belly.
very evident to all thole who happen'd to be prefent : on the other hand, the
right was fo much dimintfh'd in its fize, as not to exceed th is and
thicknefs of the ren fuccenturiatus ; and to the fmalinefs of this kidney, the
ureter, and the emulgent vefTels, correfponded. And that you may not fup-
pofe it to have been thus from the original formation of the bodv, it was
of a colour which fhow'd it to be morbid •, and had ftiil the tubuli which are
wont to receive the papillae, but contracted in their diameter, and the re-
maining fubftancc redue'd almoft to nothing : fo that if you took away a
calculus, which was not at all red, and not at all of a faffron colour, and
which lay in the kidney, and a calculous matter here and there, fcarcely any
thing would remain.
13. As to what I have faid, that this obfervation could not be without its
utility •, I would have you underftand it in fuch a manner, as to fuppofe t hat
it gives us occafion of examining many things which have been ailerted by
phyficians, when they have treated of calculi, and other diforders of the
kidney •, as appears even from that twenty-fecond fectioa of the Sepulchre-
turn.
And firft, although it happen'd to Coiterus (0) to find " the right kidney
" more liable to ulceration than the left," and tho' it happen'd fo in our wo-
man alio, yet if you run over this whole lection, you will rind that out of the
kidnies, the fubftances of which had been ulcerated, or confum'd, the num-
ber is greater on the left fide, than on the right : and indeed if the more fre-
quent caufe of ulceration is to be fought after in calculi, thefe are, in the
opinion of Boerhaave ("/>), lefs frequent in the right : nor have learned men
fail'd to aflign a reaion for this difference (q) ; I mean, becaufe the blood is
carried back, from the right kidney, much the moft eafily, on account of the
emulgent vein being fhorter, and more at liberty.
And though different authors have accounted for it differently, yet in the
fact itfelf all agree-, as Frederic Hoffmann (r), and ftill more Carolus Pifo
(s), whom he quotes, and who fays, in exprefs words, that " out of a hun-
dred who labour under a nephritis from calculi, more " than eighty are
" affected in the left kidney, as is prov'd by experience •," or indeed " in al-
" moft all nephritic patients •, .... which is," fays he, (/) " an obfervation
" made by Dodonjeus, as well as by myielf."
Therefore, although in turning over thofe of the volumes of the Casfarean
Academy, from which I am wont chiefly to take examples in thefe letters,
you will light on fome obfervations, that either defcribe (u) both of the
kidnies, as equally confum'd, internally, from calculi ; or (x) the right only
as being opprefs'd with them ; or (y) if both of them, the right by far the
moft •, yet you will have fo many of the others, that are proper to be eppos'd
to thefe, and indeed fome out of the fame volumes ; as, for inftance, where
(z) they defcribe calculi in the left kidney only, or, if in both of them, ei-
(0) Obf. 23. §. 3. (/) In prxf. paulo ante theor. 4.
(f>) Prelect, ad inftit. §. 352. (») Dec. 3. a. 5. obf. 33.
(7) Vid. Haller. not. g ad eund. loc. (x) Adt. t. 1. obf. 20. & 247.
(r) Medic, rat. t. 4. p. 2. f. 2. c. 6. in thef. (_<•) Cent, i.-obf. 27. & cent. 3. obf 45.
pathol. §. 6. (,~) Ibid in appen. n. 1.
(/) Obf. de morbis a fer. colluv. f. 4. c. 2.
poit. obf. 100.
4 thcr
Letter XL. Article 14. 423
ther (a) more, or (b) larger, and fuch as more confiderably affected the left
kidney than the right ; in one of which obfervations you will, by the way,
remark this, that tome parts of thole calculi were " of a chryllalline hard-
nel's, and a fhining fmoothnefs," or " pellucid." .
From the fame books you will have examples (c) of the left kidney only
being much increas'd in its fize, though internally eroded, or affected with
fome other diforder, or of the left much more than the right : and thel'c
things will be, in like manner, confirm'd by two obfervations of purulent
kidnies, propos'd by the celebrated Cofchwitz (d). But enough of examples
at pa lent : I therefore purpofely pals over others (among which is even that
:r'd to above [e), from the celebrated Fantonus) except one which that
author has mention'd (f) from the obfervation of du Verney •, as it ought
not to be pafs'd over, in order that a rare caufe of a purulent dilcharge, by
ilool, may be underitood. That is to fay, pus proceeded from the inteftinum
colon, which was eroded by an ulcer of a neighbouring part. And this part
was the left kidney.
From thefe things that have been faid, you fee, fome advantage may be
drawn, when dubious fymptoms of a renal diforder difcover themfelves, as
frequently happens, for if to others, this alio be added, that they are on
the left fide, they will become lefs dubious, than if they were on the right
fide.
14. Euftachius (g), moreover, having found, in Bonifacio Corneo, one of
the kidnies to be fcarcely equal to a fmall chefnut in magnitude, and the
other large •, but the former found, and the latter purulent, as well as turgid
"with calculi, and fanious matter ; fuppos'd that the fmallnefs of the former
was owing to a deficiency of blood : inafmuch as this fluid was carried in the
greateft quantity into the other, where it was drawn by the force, and ftimu-
lus, of the difeafe. If the fmall kidney was really found, and the fmallnefs
of it did not hide the traces of old difeafes, it is not to be wonder'd at, that
this great man was oblig'd to have recourfe to that explication.
But others are better fatisfied with a contrary explication, where the lefler
kidney is morbid, as I am alio, in the cafe of the woman in queftion. The
kidney being contracted, the veflels of it are contracted alio, as we have feen
in the prefent cafe. What blood, therefore, cannot#now be carried into this
kidney, is diverted into the other by the oppofite artery •, and, by this unufual
flow of blood, the oppofite kidney is diftended. And I believe that the con-
traction of the one, and its vefiels, and the diftention of the other, may be,
fometimes, fo far increas'd, that the latter may grow out into a very great
bulk, and the former may feem never to have exifted.
That is to fay, the found kidney, if it be firm, is not more increas'd than
the influx of blood requires ; which muft depofit the fame quantity of fluid in
one kidney, that was before depofited in both. But if it be pretty lax in its
nature, and a difeafe is added to that laxity, it is fcarcely to be conceiv'dhow
(«) Dec. 3. a. 3. obf. 122. (<-/) Differt. de Valvulis in ureterib. §. 5 $cj>
(£) Ibid. a. 7. & 8. obf. 122. cum figuris. {e) Vid. fupra n. 5.
(c) Cent. 8. obf. ice. & cent. 9. obf. 64. & (f) Anat. corp. hum. difl". 4.
aft. torn. 7. append, n. 10. & eorund. torn. 8. {g) Sett, hac zz. obf. 16.
obf. 89.
grea':
424 Book III. Of Difeafes of the Belly.
great an increafe it may fometimes acquire. This is mown by that kidney,
which the celebrated Valcarenghus (h) found to be ten times larger than
its natural fize, and (till more by that which is taken notice of in the hiftory
of the Royal Academy of Sciences at Paris (i), and which weigh'd thirty-
five pounds ; to fay nothing hereof another, which was twice as heavy as the
lad, and indeed more than twice, and which the celebrated Fantonus (k) has
taken notice of, from the obfervation of Monginotius. On the other hand,
1 haveafufpicion that the kidney has been contracted by difeafe, and even fo
attenuated, and confum'd •, in thofe who have labour'd under pains of the
kidney, from calculi, and^other diforders-, as to make learned men think that
they were originally deficient: as, for inftance, in a woman, a man, and a
girl, whofe hiftories you may fee in the Sepulchretum (I). For; to omit the
man, 1 mean that merchant, the obfervation of whom is once and again refer'd
to in this feet ion, through carelefThefs ; in the girl, although not the leaft
appearance of filaments, or membranes, occupied the place of the right kid-
ney ; yet that place was taken up by the ureter, which (till went down to the
bladder, from the trunk of the vena cava, to which it feem'd to have been ag-
glutinated, after the kidney was confum'd : and in the woman, inftead of
the right kidney, was feen " a certain kind of involucrum," the membrane,
as 1 fuppofe, which, when the fubftance of the kidney is already confum'd, is
taken notice of as remaining behind in the fhape of a purfe, or bag, by
fuch a. number of obfervers (n).
But I fhould fuppofe the kidney to have been deficient from the original
formation, as Ariftotle obferv'd even formerly (o), in thofe perlbns where no
diforders of the kidnies have preceded ; and no veftige or traces, either of its
emulgent veffels, or the ureter, exifts •, as was the cafe in the little girl dif-
fered by Poupart (p), and in the prieft, and woman, diffected by Valfalva,
each of whofe hiftories I have already given you (q) : or if any trace did exift,
fome other particular things were not wanting, which fhow'd that the kidney
never had exifted ; as in that woman, the kidney of the other fide was not
only, as in that little girl, larger than it ufually is, but twice as large as its
natural fize : and befides this, furnifh'd with a double pelvis, and double
ureter •, fo that it feem'd to have been form'd from the beginning, with an in-
tention to fupply the functions of its abfent fellow.
In a whelp which I diflected at Bologna, in the month of February, in the
year 1702, I obferv'd another thing; from whence, although neither the
ureter, nor the emulgent vefTels were wanting, I fhould, neverthelefs, con-
jecture the kidney to have been wanting from the original formation. For
when, inftead of the right kidney, I had found nothing but fat, which, in fome
meafure, refembled it, both in bulk, and figure •, and the ureter, indeed,
join'd with the bladder, but folid like a ligament ; and, a little before it
reach'd to that fat, fuddenly feparated into flender and pinguedinous ftrise,
(£) Diflert. de Taxis, acub. & cxt. - («) Vid. ex. grat. feft. hac 22. omnes §.
(?) A. 1732. obf. anat. 7. obf. 5.
(A) De obf. med. & anat. epift. 8. in fin. (0) De generat. animal. 1. 4. c. 4. art. 2.
(/) Sea. cit. obf. 23. §. 4. feft. 27. obf. I. (p) Hilt, de l'Acad. R. des fc. a. 1700. obf.
fe&. 28. in additam. obf. 2. anat. 1.
(/*) Obf. 23. §. 12. & obf. 27. §. 6. (?) Epift. 25. n. 4. & epift. 31. n. 25.
which
Letter XL. Article 15. 425
which accompanied the fanguiferous veflels •, and had feen that the emul-
gent artery, in like manner, was not wanting on that fide, but much
more fmall than it commonly is •, and when it had fent out a branch of no in-
confiderable fize, going away into l'mall ramifications, which only crept
through the furface of the defcrib'd fat : when, therefore, I had feen thcfe
things, I obferv'd that the emulgent vein, on the fame fide, although in
thicknefs it fomewhat exceeded the oppofite, did not, however, receive any
ramifications coming from that fat, or at lead; any that were obvious to the
fenfes ; as I examin'd the whole of this pinguedinous body with great care ;
but that it receiv'd a branch from the neareft lobe of the liver, fo thick in its
fize, that even the left emulgent itfelf feem'd to be thinner than this.
From this circumftance it was natural to conjecture, that the right emul-
gent vein had not been created for the fake of the kidney, in this whelp, but
tor the fake of the liver ; efpecially as it was in a creature who was very
found, and healthy, and in whom every thing elfe was agreeable to the ufual
courie of nature •, except that the left kidney was larger than in proportion to
the fize of the body, inafmuch as this was under a neceffity or fecreting the
whole of the urine-, for which reafon thefmall canals thereof were alfo much
thicker, and more evident, as I defcrib'd in the woman.
15. To return therefore from the conftitution of thefe parts, which is the
effect of original formation, to that which is from difeafe, and to the difcourfe
I had begun ; I fhould fuppofe that the magnitude of the found kidney is
increas'd by the wafting of the other, in much the fame manner as I juftnow
advanc'd ; for in the obfervations of Kerckringius, for example fake, or
Drelincurt, already taken notice of (r) •, as one kidney was deftroy'd by a
worm, and the other larger than it ought to be ; there cannot be room for
the explication of Euftachius.
But as we fee itfo often happen, that one kidney not fecreting, or not emit-
ting, urine, by reafon of its being corrupted, or on account of obftructing
calculi, is fupplied by the other, and that this is confirm'd by the very in-
creafe of it ; it is evident that Guy Patin had with reafon afferted, as you
will read in the Sepulchretum (j), the frequent fallibility of this fuppofition,
that when one kidney is obftructed the other immediately ceafes from its
office : which he has alfo prov'd by his own obfervations, and it is eafy like-
wife to conceive, from the obfervations of feveral authors-, and among thefe,
to omit a great number of others, thofe of Gregory Horftius (t), and Tho-
mas Bartholin (u).
It in reading over the hiftories of Guy Patin, and Bartholin, you fhould
be furpriz'd that, although there was a large and angular calculus in the
kidney, no pain had been wont to be perceiv'd there j you will be furpriz'd
ftill more, if you look into other obfervations, from which it appears, that
there neither had been this pain, nor any other of the great number of fymp-
toms attending renal calculi, through the whole courfe of life, in fome per-
fonswho had thefe calculi; fome of which obfervations are in the fame part of
the Sepulchretum (.v), where thofe are that I refer'd to from Bartholin 5 but
3.4.
others
(r) Supra, n. 8.
(j) Sect. hac. 22. in fchol. ad obf. 14.
(0 Ibid. obf. 19.
(a) Ibid. obf. 24. $
(x) Obf. ead. §. 1.
VOL. II.
I i i
426 Book III. Of Difeafes of the Belly.
others may be added befides •, as, for inftance, that which is extant in the
hiftory of the Royal Academy of Sciences at Paris (y) •, although in this
man, neverthelefs, vomitings were not wanting, wherewith he was attack'd
at intervals ; and that, in like manner, which I am furpriz'd has not been
already added, inafmuch as it was publifh'd in the pofthurnous work of Mal-
pighi (z).
But the caufe why fome one fymptom only, and fometimes none appears,
may indeed be manifold ; as, for inftance, when ftones, although of a con-
fiderable magnitude, are naturally, or by chance, " piere'd through in the
middle like a ring" (for thus we ought to read the words of Euftachius,
which are transfer'd into the Sepulchretum (#), in an improper manner,
v. here they are confirm'd by an excellent obfervation of the lame author's) a
fupprefllon of urine does not happen, as it will not happen likewife, if a paf-
fage for the urine, through fmall canals, as it were, in the fides of the calculi
themfclves, be left open-, as appears in the next hiftory of Salmuthus (b), and
ftill more clearly, as the defcription is illuftrated by a figure, in that which
Lancifi communicated to Alghifi (c). Nor will there be a troublefome fenfa-
tion in the loins, not even of heavinefs, if the calculi increafe gradually and
(lowly, and have not fharp angles ; or if they adhere fo clofely, and are fo
wedg'd in, to the fubftance of the kidney, that they cannot be mov'd; efpe-
cially if that fubftance be hard and callous, as I fhall tell you, hereafter (i),
that it was in the cardinal Corneli-, and as it was alio in that man of whom I
made mention juft now, from the hiftory of the Royal Academy of Sciences,
in whom it was found to be cartilaginous.
But it was alfo hard, in another whofe defcription I have faid is extant in
Malpighi. And in thefe there are, in general, no other marks of that difeafe.
And what was the caufe of this circumftance in him whofe obfervation is
gi%'en by Guarinoni (e), does not fufficiently appear from the diiTe&ion •, as it
likewife does not in two others (/), and in the firft, in particular; both of
which, neverthelefs, fhow each of the kidnies to have been ftuflf'd up with
calculi, and particularly the left. Yet what, and of what kind, thofe marks
are, for the moft part, wont to be, from the prefence of which, calculi of the
kidnies are properly diftinguifh'd, although you know very well of yourfelf
already •, it will, neverthelefs, be of ufe to enquire, over again, in the writ-
ings of the celebrated Scharfchmidius (g) % for he fubjoins examples by which
he confirms, that moft of them, or even all of them, may be abfent fome-
times, fo that the phyficians may have an eye to another difeafe, and may by
no means fufpecit that calculi are in the kidnies.
Moreover, it is ncedlefs to admonifh, that caufes may arife, on account of
which, the pain that was before even very fharp, in the kidney, may ceafe :
that is in confequence of the fmall nervous branches being either become in-
capable of feeling acutely, or being confum'd ; as is underftood from the
fixth obfervation of this fedion. And as this is the ftate of the queftion,
(y) A. 1730. cbf. anat. 5.
(*) Ubi de mi'>.
(a) Se:t. cic. cbf. 1.2. §. 1.
[A) Ibid. §. 2.
(c) Liib/Jtom. c. 4. & tab. 4.
{1!) Epift. 57. a. 10.
(e) Sepulchr. 1. 2. f. 1. in additam. obf. 10.
(f) A&.. n. c. torn. 2. in append, n. 3. &
Commerc. Litter, a. 1745. nebd 11. n. 1.
(g) Ibid. a. 1739- hebd 31. n. 1.
5 ^
Letter XL. Article 16. 427
it appears of how much importance it is to enquire what fymproms have
preceded in patients-, and if, at any time, DO peculiar fymptom of a renal
calculus exifts, not for that reaibn to delpifc the (lighter fymptoms, or thofe
which are alfo common to other diforders. But my obfervations of this dif-
ealc being found in dead bodies, will better teach us this, though thej
defer'd to other letters for this reaibn; becauie it does not feem lo proj er to
give them here, where the quedion is of pain in the loins-, as, in theft patients,
no pain of the loins had difcovcr'd itfelf.
16. But as to what I have laid, that, in the kidney of the woman defer ib'd
by me, the calculus was neither of a faffron colour, nor red ; and as to my
having taken notice to you, in another letter (Z>), that three white ones were
found by me ; it is, without doubt, contradictory to that diltinction, which
was formerly rcceiv'd by every-one •, fuppofing that flones generated in the
kidnies, were to be known from thofe generated in the bladder by one or
other of thele two colours. To whom, you fee in the Sepulchretum (/'), that
Euftachius has objected this obfervation : and from the Sepulchretum, alfo,
you will add others -, as out of thofe which are at hand, another next to that
of Euftachius (£), wherein they are defcrib'd as being of the colour of white
marble ; and another (/), wherein calculi, found in the kidnies, are faid to
be of a fnowy whitenefs : where fome have been feen by Valfalva, of a white
colour (as they were alfo by Schroeckius (m) ) which I have taken notice of in
another letter ; and fome of a black colour, as I have taken notice in this very
letter (;;).
It appears, therefore, that this diftinction has either been taken from to:>
fmall a number of obfervations, or from ibme prejudg'd opinion. And, cer-
tainly, that (tony matter by which it is ting'd with a red, yellow, black, or
any other colour, may be mix'd with it when it is in the bladder. From which
variety of mixture, it is to be fuppos'd that the different facility, or difficulty,
of folution, in different (tones, happens ; and that, for this reafon, all hope is
taken away from thofe perfons who enquire after a remedy, by which they
may be all equally diffolv'd. And we ought, for this reafon, to take the
greater pains to prevent a calculus being generated, by avoiding thofe things
which I have faid (o) tend to retard the urine in the kidnies, and by making
ufe of the contrary, efpecially if there be any fufpicion of a calculus being
begun. In order to remove which, while it is poflible, I would rather ufe
the more mild diuretics, and fuch as have fomething of an anodyne nature,
than the more acrid ones •, as on the one hand, I remember, that before the
Monita of Boerhaave (p) came forth, a certain gentleman, a fellow citizen of
mine, who had had a (tone cutout from his bladder, and who was fubjecl to
nephritic pains, began to be lefs frequently attack'd therewith, from the
time that he determin'd to drink, on every third or fourth day in the morn-
ing, fome ounces of warm water, with the addition of a fpoonful of fyrup
made from the juice of violets •, and as, on the other hand, I know that
diuretics, properly fo call'd, have really freed fome perfons from the com-
{b) Epift. 38. n. 41. (w) A£t. n. c. torn. i. obf. 247.
(/) Seft. hac 22. in Schol. ad §. 1. & §. 2. («) N. 2.
(&) Ibid. §. 6. (0) Supra, n. 3. & 5.
(/) L. 1. fed. 10. inadditam. obf. 8. ad fin. (p) Praded. ad. iniit. $. 365 & 3F7.
I i 2 1 laints ;
428 Book III. Of Difeafes of the Belly.
plaints ; but have very much hurt others : nor will this be furprizing, to thofe
who either attend to what I have hinted above {q)y of the mucilaginous hu-
mour, wherewith the parietes of the tubuli, and the pelvis, are fmear'd over -,
and how cautious we ought to be in removing it i or to the contractions of the
fame parietes, which, as they naturally follow the irritation of acrid medicines,
it is evident mull not only aftringe the paflfages to an improper degree, but
greatly increafe the pains.
I could wifh the anodyne virtue of the fquil, and its power in appeafing
convulfions, hinted at by Hoffmann, and afferted by the celebrated Jo. Ge-
rard Wagner (rj, in the nephritis itfelf •, even when proceeding from fmaller
calculi; were confirm'd by a great number of other fuccefsful experiments-, (b
as to be not lefs known among phyficians, than the diuretic property thereof:
for certainly our Italians alfo, notwithftanding they are, in general, averfe to
the ufe of emetic medicines, fuch as the pulvis fcilliticus is, would not be in
doubt to make a proper ufe of it, in order to prevent a calculus from increaf-
ing in its fize, in a part from whence it could not afterwards be difcharg'd.
For by remaining there long, it is fo increas'd, as not only to be too large
for being diflodg'd, and got rid of, but even, fometimes, lb as to equal the
kidney itfelf in fize ; and it has been known, more than once, to have been
of the weight of five pounds, as it is faid to have been in a woman of princely
rank (j). But as, in other diforders, the fame remedy has not the fame
effect, at all times, fo in this does it happen thus in particular. At leaft, I
remember Valfalva to have complain'd of this more than once ; and to affirm
that, in the cafe of a noble virgin, who had been troubled, for the fpace of two
years, with pains of the kidnies, he was oblig'd to change his remedies in
every paroxifm ; fince thofe which had given her immediate relief before,
were applied to again without efFect.
17. Among the other mifchiefs, which nephritic tortures bring to women,
I do not doubt but abortion, or even the death both of mother and child,
ought frequently to be reckon'd. For as the increafing uterus, by prefTing
the ureters, renders the deflux of the urine through them lefs eafy, and con-
fequently fomewhat delays it in the kidnies ; if it happen jhat any woman has
a diforder in thefe parts, which makes her fubject to pains thereof; it is
without doubt very natural to fuppofe, that their internal membranes are,
from thence more irritated, and that tortures are excited -, as it is likewife to con-
ceive that the whole body, and particularly thofe parts which lie in the belly,
being drawn into confent therewith, by means of the nerves, the foetus may
eafily be extruded from the uterus, by the contractions thereof, before its
proper time : or at leaft the foetus itfelf, or the mother, who are very fre-
quently unequal to the conflict with violent diforders, may fuffer very much
therefrom ; fo as frequently to make it impoffible for either of them to efcape
death.
In regard to abortion, you have, in the Sepulchretum (f), the hiltory of
the matron defcrib*d by Platerus. She " having been fourteen times preg-
" nant, had as often mifcarried, in the eighth or ninth month of her preg-
" nancy." The fame woman had been fubject, for many years, to the molt
(q) N. modo indicato 3. (s) Vid. apud. Pohkde proftat. calcul. §. 7.
(>) Obferv. Clinic, feft. 2. n. 2. 9 & 10. (*) Seft. hac 22. obC 4..
violent
Letter XL. Article 18, 19. 429
violent pains of the kidnies. And Platerus found " the caufe of her pains,
" and abortion," in the kidnies; one of which was redue'd into the form of
8 purfe, by a waiting of its fubftance, and the other was very tumid with a
large calculus.
And the woman, from whole hiftory I have had occafion to obferve this,
as well as other things, that (lie, herfclf, firft died in the leventh month of
her pregnancy, and her foetus alio foon after, and have already fliown you
(u) what appearance her right kidney had ; gives me at prefent, occafion to
lufpect ; though, being then bufy about other things, I did not enquire into
the nature of her death •, that the pain of her kidney had been one of the
preceding or proximate cauies thereof. And this I alio fufpect of another
woman, the account of whofe direction was communicated, by Santorini, to
me and the reft of his friends ; whofe obfervation 1 mall the more readily
give you here, becaufe it alio contains fome other things, which will not,
perhaps, be at all dilpleafing to you, when you enquire into the itructure of
the kidnies.
1 8. A woman, who had labcur'd under diforders of the kidnies, being
pregnant, at length died in the fifth month of her pregnancy.
One of the kidnies was wrinkled, and contracted j inafmuch as, notwith-
flanding the cavity of the pelvis was dilated confiderably, the fubftance of
the kidney, itielf, was much diminifh'd in thicknefs. The fubftance of the
other likewife, although increas'd in length, and breadth, had a very incon-
fiderable thicknefs in fome parts, though the pelvis was extremely enlarg'd.
But this pelvis terminated in a ureter, of fo narrow a dimenfion, that it was
fcarcely pofiible to force any air through it. And where the pelvis coher'd
with the internal part of the kidney, it was piere'd through with wide orifices,
which communicated with large cells. One of thefe cells, alfo, had its
parietes perforated with other orifices •, into which the air being driven, dis-
tended a great number of the fmall canals, and the emulgent artery at the
fame time. And thefe fmall canals were plac'd upon the arterial branches
tranfverfly. However, thefe cells were fill'd with urine-, but the furface of
the kidney was made up of fanguiferous veifels, compacted, as it were, into a
kind of thickifh ftratum.
19. They who do not entirely defpife making ufe of morbid conftiturions
of the vifcera, and the kidnies among others, to diicover the ftructure there-
of, will not, perhaps, make light of this ; from whence they will, probably,
fuppofe it to be prov'd that the fmall canals, or tubuli, of the kidney com-
municate immediately with the artery -, whether with juftice, or not, it is
not the proper place for inquiring here, nor for confirming an experiment
which I formerly thought of (x), in order to difcover the ftructure of the
kidnies.
From this hiftory, and others, taken notice of above, I rather recal ano-
ther to mind, which you will find in the Sepulchretum (y), being transfer'd
thither from Willis. In this obfervation a matron is defcrib'd to us, who had
been troubled for many years paft, but particularly when ihe had conceiv'd,
with fpafmodic affections ; in confequence whereof ihe always mifcarried about
(u) N. 12. (y) L. 1. fett. 13. obf. 7.
(xj Adverf. anat. 3. animad. 33. vid. et
epift, anat. 3. n. J5.
2 the
43° Book III. Of Difeafes of the Belly.
the end of the third month, which had happen'd lately alfo •, that is to fay, by
reaibn of acute pains frequently returning, efpecially in the loins, and theie
troubling her afterwards, alio, in a violent manner, and being attended with
a vomiting, even almoft to the very laft day of her life, which was the thirty-
fifth day after mifcarriage. When the body was diflccted, and examin'd,
Willis did not doubt but the caufe of the pains had confided in water found
within the cranium, which had fallen down from thence, through the nerves,
into the center of the mefentery, and torn afunder the membranes^which
he found to be feparated from each other, in that part, by interpos'd air, juft
as if they had been blown up by a butcher.
I confefs I am not one of thofe who deny that water, overflowing the brain,
may excite fpafmodic pains. Yet it is, neverthelefs, more natural to conceive
that in a body, which he fays had very foon putrefied, this air that was interpos'd
betwixt the membranes, had rather been recently extricated by putrefaction,
than that it had exifted in the living body. What are we then to fuppofe ?
Perhaps another caufe might have been found in the kidnies, that you might
have added to this water. For he fays that the kidnies were pretty found ;
but that one of them " was of an unufual figure," inafmuch as " it was di-
vided into many lobes, like the kidney of a calf." For call to mind what
Ruyfch (2) fays he had met with more than once.
After intolerable pains of the loins, he found, inftead of calculi, which he
and every one expected, only an unequal furface of the kidnies, as in human
foetuflTes, in calves, an in oxen. And he confeffes that, as the circumftance
itfelf was new and unheard of to him, fo alfo he had not found out, by what
means fo violent a pain, and a frequent difcharge of bloody water, could
arife from a ftruclure of this kind. For although this difcharge of bloody
water is not mention'd by Willis, yet that internal diforder of the kidney,
which would either be the effect:, or the caufe, of this inequality of furface,
might not as yet have reach'd to fuch a height, as to caufe a difcharge of
blood, together with the urine. We are exhorted by Ruyfch to enquire
what kind of diforder this is, but of what nature it is it will not be ealy for
any one to conjecture, before he knows whether all adults, who have this,
inequality of their kidnies, are troubled with pains of thefe parts.
20. Therefore, if the things which have been faid by the more ancient
writers, are attended to, any one will think, at firft, that this is not true.
For as Ariftotle (a) has afferted, " that the kidnies of men are like to thofe
" of oxen, inafmuch as they confift of a composition of many very fmall kid-
" nies, and are not equable ;" it may feem that they were found fo in the
greater part of bodies at lead : yet that the greater part of men were, at that
time, troubled with pains of the kidnies, cannot, I think, feem probable to
any one.
But if we fufpect that he was indue'd to make this aflertion, from the in-
fpeclion of foetufles, and young children •, which fufpicion is hinted at in the
annotations to Euftachio's book of the kidnies (b) ; we mull fet afide Ariftotle,
and enquire how often the fame has been feen by others, in what fubjefls
(z) Adv. anat. Dec. 1. n. 9. (£) Ad c. 3. in fin.
(a) De parcib. anim. 1. 3. c. 9.
they
Letter XL. Article 20. 431
they were feen, and by whom, Euftachius (Y), who examin'd as many kid-
hies as any one whatever, has told us, i ,r he hail met with th s appearance
in one or two only ; and although he does not lay that they had labour' d un-
der any renal diforder, he ken-, n verthclefs, to hint it hi lome meafure,
when he lays that the kidnies of one u were oi a very remarkable magnitude
" alio, and one which far exceeded others •," and when he, in another place (d),
denies that this appearance .would be found, " unlefs we have tidier got a body
tk whole kidnies abound with tubercles, or nature lias deviated from her own
" laws in forming them."
And as this is laid to happen " very feldom," by fo fkilful an anatomilt,
it would be very furprizing it fliould have been, afterwards, aflcrted by Vef-
lingius (c), that the kidnies, " however, frequently retain, in adults, that
*' inequality of furface, as if made up of a number of glands compacted to-
" gether, which they exhibit in the foetus •" if it were not more jult to
interpret him thus ; that is, by fuppofing him to have laid f<epius, not fo
much to fignify frequently, as by way of comparifon with what he had faid
before, which is certainly more rare ; I mean, that one kidney is fometimes
found in (lead of two •, more jult, I fay, than to blame him, as Riolanusf/) does.
Againft whom, when denying that he " had ever feen it," Dominico de Mar-
chettis (g) ib defends Veflingius, as to affirm, that he had demonftrated it
" two or three times," in this theatre. But neither of them has mention'd
a word, wliereby we may underftand whether the pafients, in whom they
were found, had been healthy or difeas'd. Nor, indeed, has Diemerbroeck
(i>), who once law the fame appearance, mention'd any thing ro this purpofe :
nor others, whom I defignedly omit ; efpecially thofe who are more modern
than lie, if you except two, one of whofe obfervations you have in the Sepul-
chretum (*'), and the other in the Bibliotheca Anatomica(£).
The latter affirms, " that he had once had an opportunity of feeing this Jo-
" bulated ftate of the kidnies, in a young man of nine years of age, where it
" was very evident, and manifelt $ this vifcus being, in the mean while, af-
" fected with no difeafe whatever." And the former, " in a girl of ten.
" years of age," who was troubled with very fevere pains of the belly, which
brought on convulfions and vomitings, whereby fhe was at length carried off;
although he obferv'd feveral morbid caufes in other parts, neverthelefs found
the kidnies to be very hard, and one of them " of an unufual figure, that
*' is to lay, filTur'd into feveral lobes." But if you fet afide this lad on
account of thefe feveral caufes, and both of them on account of their age,
not being quite adult ; for it would not be very furprizing if, in fome bo-
dies, both the kidnies, or one of them at leaft, fhould lofe that inequality
which is natural to children, fomewhat later than ulual in life ; out of the
other obfervations that I at prefent remember to have read, there are no more
than four of this kind, one of Ruyfch's, another of Petruccio's, a third of
Mauchaiv's, and the lalt of Trew's. And from the two firlt obfervations, if
(r) C. cit. (h) Anat. 1. i.e. i3.
(d) C. 42. (/) L. 1. feet. 13. obf. 3. in additam.
(e) Syntagm. anat. c. 5. (k) Tom. 1. p. i,in adnot. ad c. 1. Malpigh*
(f) Animadv. in cit. Veflingii locum. de Renib.
Q) Anat. c 5.
we
432 Book III. Of Difeafes of the Belly.
we attend to fome circumftances that were join'd with them, we (hall con-
jecture, chat they, in whom kidnies of this kind were found, had labour'd
under diforders of the urinary paflages. «**-
For Ruyfch, formerly, before he gave us thofe two cafes which furnifh'd
me with an occafion of confidering thefe things, having found the fame ftruc-
ture of kidney in an adult ; although he has hinted nothing in regard to his
difeafes, in the delineation of that kidney (/)•, neverthelefs reprefented the up-
per tract of the ureter to us, as being wider than it generally is in its natu-
ral ftate, in thofe who never have been affected with renal diforders : and Pe-
truccio, when in the fecond table of his Spicilegium (m), he reprefents mon-
•ftrous kidnies j that is, kidnies " confifting of a great number of glands,
" wrap'd up together like a clufter of eggs •" reprefents the pelvis of the
right kidney as being more wide, and more protuberant, than is natural ; and
the ureter of the left, according to what himfelf fays, as being " monftrous,
" both in refpect to thicknefs, and to largenefs." And in the obfervation
of Mauchartus (n), there is no need of conjecture to make us fuppofe that
the old man, who had his kidnies " very large, and unequal, like the kidnies
*' of oxen," had labour'd under many and confiderablc diforders of the urine,
and the parts deftin'd thereto. For it is certain that he had been nephritic
for fome years •, that after this an almoft perpetual ifchury had fucceeded, and
then, an incontinency of urine at intervals : and that within the ureters.
which were .liftendeoHike the inteftinum ileum, urine was found like " but-
"* termilk •* whereas the pelvis, on both fides, from whence they proceed-
ed, was equal to the capacity of an egg : and, finally, that within the blad-
der, which was contracted, thick, and, in a manner, callous, two ftones, one
of which was large, had been contain'd ; not to mention that many had been
formerly dilcharg'd.
So, alio, another old man ; in whom both the kidnies were feen, by the
celebrated Trew (o), to be " remarkable on account of their manned divifi-
*' ons into lobules, as, at other times, generally happens in children only ;"
had been for a long time, when living, fubject to calculi of the kidnies,
which he fometimes dilcharg'd, in conjunction with bloody urine, till by a
fecond fuppreffion of urine in the bladder, he was carried off. Now if you
ihould afk me what I have obferv'd ; although as often as ever I have hap-
pen'd to light on kidnies of this kind, it was in poor people, and thofe, for the
molt parr, unknown ; and though, for this reafon, it was cither impoffible
to know at all, or at lead latisfactorily, to what diforders they had been fub-
ject while living -, yet this I will fay, that from fome marks it is allowable to
conjecture, jult as in the obfervations of Ruyfch, and Petruccio, that none of
them had been totally free from diforders, in which the urinary organs were
concern'd. Which you yourfelf, alio, will, I hope, eafily understand, when
you have confider'd thefe hiftories which I fubjoin, but confider'd them in
general-, for I fhall fo difpofe them, that you will fee thefe marks, or tokens,
to be more and more increas'd, as you proceed ; and, from more flight, to be-
come gradually more violent.
(/) Obf. anat. chir. 80. fig. 64.
(m) De ftruct. capfular. renal.
(n) Eph. n. c. cent. 8. obf. 26.
(0) Commerc Litter, a.
n. 3.
1743-
hebd.
33>
21. Some
Letter XL. Article 21, 22, 23. 433
21. Some of the vifcera, and the head, of a woman wlio died in this hoi
pita), were brought to the college, at the time I was teaching anatomy, in
the year j 726.
The medullary Jubilance of the cerebrum was brown, and mark'd with
frequent bloody points : the lateral ventricles were not free from water cxtra-
vafated within them: the cerebellum w as very fofr.
Both in the cavity of the thorax, and of the belly, was there fome water,
which was very foul. The tubes of the uterus had their larger orifice (hut
up, in COnfequence of being firmly agglutinated to the ovarium, at that
extremity, Both of the kidmes were unequal in their furfacc, and variegated
with white fpots, where the furface fubfided; lb that you might eafily per-
ceive this inequality not to have been natural. And the urinary bladder was.
internally red.
22. I demonftrated the parts of 'a certain old man, and particularly thofc
of the belly, to our ftudents, in the fame hofpital, about the end of the
year 1742 ; when among them, I remark'd theic to deviate from the ufual
appearance of nature.
The tunica vaginalis of one of the teftes contain'd a pretty large quantity
of water, and that turbid : and from the albuginea, which inverted the te-
fticle, near to the fuperior globe of the epididymis, was prominent a round-
ifh body, of the fame colour with the albuginea. The great artery, where it
divided itfelf into the iliacs, contain'd little bones within its coats. But this
was nothing when compar'd with the fplenic artery, which, from its begin-
ning quite to its entrance into the fpleen, confided, almoft univerfally, of
bones -, and was befides this, much more wide than is ufual. Yet the fpleen
was, as far as appear'd to the fenfes, in a found date. The gall-bladder was
•lefs than it naturally is. The kidnies were fmall in proportion to the ftature
of the man : and although they feem'd to be found internally j yet externally
their furface was unequal. The urinary bladder was large, and had very
thick parietes, inch as there generally are in thofe who have labour'd under
a difficulty in their urine, from a calculus, or from any other caufe.
23. Another old man, to appearance of fixty years of age •, and fo very beg-
garly and poor, that he even pick'd up a forry fuftenance from the outfide-
rinds of melons, which were thrown out into the ftreets, or any thing elfe
of that kind ; had come, once before, into this hofpital, on account of a fe-
ver, and a fenfe of opprefllon in the thorax, which were accompanied with
a difficult refpiration, a weak pulfe, and a continual cough ; whereby what is
commonly call'd a catarrhous matter was difcharg'd. When he feem'd to
himfelf to be fomewhat reliev'd, he went out again into the ftreets, and not
long after came to the hofpital again. La ft of all, about the middle of Ja-
nuary in the year 1747, he return'd fo emaciated, and fo broken down, by
difeafe, cold, and hunger, that he died a little after coming in.
1 made ufe of this man's body, in my public demonftrations, till I could
fupply myfelf with a better. I therefore examin'd the vifcera of the thorax
and belly, To (peak thenfirilof the thoracic, from whence you may judge
.of the caufe of the principal dilbrders, in this man ; the thorax, as well as
the pericardium, had a fmall quantity of water extravafated in it. But the
luno-s were ftrongly connected to the fides, and the back : and, indeed, the
Vol. II. -Kkk right
434- Book III. Of the Difeafes of the Belly.
right lobe, when it was drawn away, left a kind of opaque, thick, firm, and
equal coat behind; adhering to the parietes of the thorax-, extended quite
from the lower part beyond half its length •, and from the fpine almoft to the
fternum •, which being pull'd away at one extremity, and after that from the
fternum, follow'd all together: this membrane neither belong'd to the pleura,
nor to the membrane of the lungs, for both of thefe ftill remain'd in their
fituations ; I therefore fuppos'd it to be of that kind which I have already (p)
explain'd to you. The lungs themfelves were not extremely found ; and
fomething hard was even perceiv'd within the upper part of one of the
lobes.
But there was much greater mifchief in the heart. This vifcus was twice as
large as it ought to have been : yet it did not contain blood, but polypous
concretions only, and thefe fmall and few. But as both the ventricles were
dilated ; the parietes of the right were very thin, as thofe of the auricle, on
the fame fide, were alfo ; on the other hand, thofe of the left ventricle were
all thicker, and harder, than is natural. The valvular mitrales themfelves
were enlarg'd alfo, very thick, and tuberous, on their lower edges. And
the figmoid were lefs foft than is natural •, but the femilunar were ftill lefs
flexible than them : and, indeed, one of thefe, in a part of its lower cir-
cumference, was already bony.
The great artery was wider than natural before its curvature ; and, on the
whole of its internal furface, was diftinguifh'd, here and there, with white
fpots, as the internal furface of the iliacs was alio. Some of thefe fpots were
prominent on the internal furface : and thefe were very hard and bony ; efpe-
cially where one of the inferior intercoftals took its origin, whofe orifice, hap-
pening to lie in the center of the fpot, which protuberated in a circular cir-
cumference, had been fo ftreighten'd on this account, that together with the
fpot, it at firft fight refembled a kind of lenticular gland, of a large fize.
And fince I have made mention of the iliacs ; before I add the other circum-
ftances which related to the belly ; I will not conceal this, that all the iliac arte-
ries were tortuous, juft as we fee the fplenic to be: but that the iliac veins,
the firft only, that is quite to their partition, were affected with a kind of cor-
rugation, as it were, fo that it was with difficulty you could extend them.
The vifcera of the belly fhow'd thefe marks of difeafe. The ftomach
was large, although it contain'd but little-, and being without rugse, was in-
ternally of a brown colour, in feveral parts, to a confiderable extent, from
the middle towards the left fide : and ftill more towards the oefophagus ; and
there fomewhat more deeply. The whole convex furface of the liver, except
a little fpace on the right fide, and at the lower part, coher'd firmly with the
feptum tranfverfum : but in that upper furface, the fubftance of the liver was
hollowed out with an hydatid, the diameter of which was equal to a finger's
breadth. And the convex furface had its membrane of a whitifh colour in
one place, and in the midft of that whitenefs it was become bony for a little
fpace. The fpleen itfelf was fomewhat lax, and larger than natural in its
thicknefs, rather than its length, or breadth -, whereas the fplenic artery, ne-
verthelefs, feem'd to be fomewhat wider than even this increas'd thicknefs re-
quir'd.
(j>) Epift. 20. n. 37.
The
Letter XL. Article 24. 43 5
The glands of the mefentery occur'd here and there, though in a man of that
age •, and many of them wereof the bignefsof a bean: yet it you touch'd them,
or examin'd them, alter being cut into, you could not be in doubt that they
were free from difeafe.
But the magnitude of the kidnies, which was left than that of the body In
proportion, and it 1 11 more the furface of them, dilVcr'd from what I have been
generally wont to lee. For on their pofterior furface, they were equally con-
vcx, as on their anterior -, "both of them being unequal, and, in fome mea-
fore, tuberous ; but efpecially in the left kidney. In the left, alfo, were cer-
tain deprcfiions, as if trom cicatrices. And the orifices of the ureters were
feen to be fomewhat larger within the bladder, than they naturally are •, the
bladder itfelf was internally reddifh, and diftinguifh'd with languiferous vef-
(els, running here and there, as if the velfels had been fill'd with a colour'd
; and externally it was furnifh'd with redder fibres than it gene-
rally is.
24. A ruftic old woman, who was of a fmall ftature, and immoderately
lean, died in the fpace of two days, as was {aid, of old age •, but fhe had
labour'd under a difficulty of breathing, although without a cough, or any
expectoration whatever : which remark I make, that you may know this to
be all it was poffible for me to learn of her difeafes •, not becauie I examin'd
any other vifcera, but thofe of the belly. For, although the body of this
woman was alfo brought from the city, into the theatre, when I was teaching
anatomy in the year 1 740 •, yet, when I came to the thorax, I was furnifh'd
with a better, or at lead with a larger body •, the diffection of which more ef-
fectually anfwer'd my purpofes.
The abdomen, therefore, of this old woman being open'd, all the other
parts were found, and thefe only were found to be preter-natural in their
appearance. The large artery, from the diaphragm, quite to all the iliacs,
was univerfally unequal from yellow bony lamellae ; and disfigur'd, befides,
from a thickifh humour ; which was brown, and of a bloody colour, and ad-
her'd, here and there, to the internal coat ; from whence, when broken
through, and ulcerated, it had diftill'd betwixt thofe lamellae that lay round
about. A dilbrder of this kind being alfo propagated into the very fhort
trunk of the cseliac artery, had, without hurting the other branches of it,
fo far extended itfelf into the fplenic artery, that, although it was univer-
fally wider than it naturally is, and had its coats thicken'd j and had, in par-
ticular, fo many and fo confiderable flexures, that I do not remember to have
feen more, or larger, therein, at any time •, and, for that reafon, feem'd to
be, ac firft fight, what it really was not ; it was, moreover, hard at the places
of its flexure, and not without offification. The fpleen, to which it went,
was found, and, though but fmall, correfponded very well, in proportion,
to the fize of the liver, and the other vifcera •, and even to the whole body.
However, the trunk of the hepatic duct was larger than it generally is. The
uterus, on the other hand, which we found very much inclin'd to the right
fide, had fo narrow a cavity, that I certainly never faw it narrower in an
adult; yet the vagina was not fmall, and the fkin, being ruguous above the
pubes, fhow'd that the woman had brought forth children.
K k k 2 Both
436 Book III. Of Difeafefi of the Belly.
Both of the kidnies were of an unequal furface, almoft as they are In the
foetus •, and not only the pelvis, and two pretty large tubes which join'd to
it, were prominent on the outfide of the kidney, but many tubes alfo of a
fmaller fize, which went to one or the other of thefe large ones. Ail which
were fomewhat wider than they naturally are, as the ureters were alfo, and
efpecially on the right fide. But the right kidney was much lefs than the left ;
and although internally, as far as I could judge by my fenfes, it was not mor-
bid, yet when difTected it had a very ill fmell. And the right ureter open'd ■
into the bladder with a much wider orifice than it generally does, and with a-
much wider orifice than the left ; fo that the woman leem'd to have labour'd
under diforders, of the urinary paflage, more on the right fide, than the left.
Then, alfo, it wasperceiv'd why the bladder could not well have been diftended,.
by blowing in air through the urethra, inafmuch as a part of it was diverted,
by that large orifice, into the ureter, and even the pelvis of the kidney (as-
I plainly faw) and went out where the pelvis had been cut into.
However, the internal furface of the bladder was, almoft univerfally,
mark'd with fanguiferous vefiels, and the fmall tumid branchesthereof, which-
were of a blackifh colour ; and, indeed, the whole lower part of the bladder
was univerfally black, to a considerable degree.
25. To thefe I would have you add the obfervation upon the liable -keeper, .
which I have defcrib'd to you already {q). For from hence you will fee what,
were the diforders of the bladder, and ureters-, and from the others, that the-
furface of the kidnies was unequal. Nor is it of any importance, nay, per-
haps, rather furthers my purpofe, that I obferv'd certain diforders in thofe-
kidnies befides. For I do not think we are to inquire here, whether the .-
injury of this furface alone, brought on thofe very violent diforders that are
fpoken of by Ruyfch (r). F mould perhaps believe, if I could admit of what-
was fuppos'd by Riolanus (s), that the furface of the kidnies •, inftead of be-
ing unequal, as it is in infants ; is, after feven years of age, or fooner, form'd
into an equality ; becaufe a flefhy cortex is thrown around it by an afperfion of
blood : a cortex which is fomewhat livid, as thick as a man's little finger,
and furrounds all thofe tuberofities which, of themfelves, make up the
fubftance of the kidney in a child. For in the foetus, alfo, the cortex exifts
in the fame proportion, and compofes the furface of the kidnies ; and be-
fides, all the kidnies of adult perfons, whofe furface was tuberous, would be
fmall, which is what I have not always feen : and that delineation of Ruyfch,
which is refer'd to above (I), i3 diametrically repugnant to the fuppofition.
Yet, on the other hand, we are not here to fuppofe, that the kidnies were
fo much difeas'd, as in fome of the obfervations of Euftachius (u), and
I.ittre (x): in which, not only the kidney was externally full of tubercles, but
had its fubftance, alfo, greatly decreas'd, or quite confum'd •, the place thereof
being occupied by a fandy matter, and the pelvis being fill'd with innume-
rable little ftones, or a matter of that kind ; and the beginning of the ureter,
in fine, being quite ftop'd up by a calculus of no fmall magnitude. For i£
(7) Epift. 4. n. 19. (t) N. 20.
(r) Supra n. 19. \u) De Ren. c. 45.
(s) Animad. cit. fupra ad n. 20. & Anthro- (x) Hift. de l'Acad. R. des fc. a. 1701. obfV.
pogr.l. 2. c. 26. anat. 5.
2 in
Letter XL. Article 26. 437
inone or the other of theie cafes, thofe fymptoms had preceded, wh h arc
fpoken of by Ruyfch ; for in neither of them was there any thing of this
kind, not even in the time immediately preceding death, which ic. very fur-
prizing} certainly nobody would have been at a Joft to aflign a reaibn why
they mould happen, as they, on the contrary, did in the oblervations ol
Ruyfch.
Now if befides the external tuberofuies you fuppofe any thing on the fur-
face, or internally, which'we may remark by attentive inspection and ob-
fervation •, as in almoft all our hillories ; from whence it may be conjectural
whatcaufe of inequality had preceded, and what cauie was capable or bring-
ing on the appearances of this kind ; as well as the pains, and the difcharge
of bloody urine; perhaps fomething will fecm to be pointed out, which is not
immediately contradictory to probability.
Suppofe then, that many of thofe cavities fill'd with ferum •, which I have
defcrib*d to you, in a former letter at large (y), and one of which was even
then remaining in the ftable-keeper ; had previoufly exifted in the furface of
the kidney. By reafon of this ferum, being fometimes very acrid in its na-
ture, the kidney might not only be Simulated, but fome fanguiferous veffcl
eroded, from whence a difcharge of bloody water, and pain would arife •, and
this pain might alfo happen to be increas'd from a quantity of ferum, which
both diftended and overloaded the part. And when this ferum is difiipated,
I have ihewn that cicatriz'd ipots and depreflions remain behind ; and thefe
in one of the hiftories produe'd (z)t not altogether obfeuce : between which
frequent depreflions, the uninjur'd fubftance of the kidney being, here and
there, prominent, will render the furface unequal, and refemble a kind of
tuberofuy. Here then you have what came into my mind, upon an obfeure
and very difficult queftion. But I would haye you fuppofe it to be advane'd
only for the fake of example, and by way of ftirring you up to invent a bet-
ter hypothefis : nor indeed am I fufficiently pleas'd with it on many accounts,
but particularly becaufe I am afraid, left: that inequality, which was feen by
Ruyfch, was different from what has been feen by me, and explain'd in the
belt manner I was able. Since, then, we have confider'd the caufe of pain in
the loins, as the effect of a difeafe in the kidnies ; fitft from calculi, and7
after that, from other caufes ; let us now confider it as arifing from the
diforder of other parts alfo ; and that by propofing an obfervation or two.
26. A carman of Padua, betwixt thirty and forty years of age, who wa?
before healthy and robuft ; except that he had labour' d under the lues ve-
nerea •, having by chance fallen down, fo that the wheel ran acrofs his belly
as he lay, was feiz'd with fuch-fevere pains in his loins, and back, that he
was oblig'd to confine himfelf to bed, for eight months together; the phyfi-
cians, whom he had fent for in pretty great number, not being able to be
of any fervice to him for thefe pains. At length when the celebrated Val-
Hfneri had come to him, and had obferv'd the patient to complain of vio-
lent pains of the loins on the left fide in particular ; by applying his hand to
the fide of this very part, he perceiv'd a pulfation as from an aneurifm ; and,
(j) Epift. 38. n. 39. & feq. U) N. 21 & 23.
for
438 Book III. Of Difeafes of the Belly.
for that reafon, prefcrib'd fuch things, as would have tended, perhaps, to
preferve the patient for a very long time, though not to cure him.
After that this place fwell'd : the tumour extending itfelf pretty wide, and
raifing up even the ribs that lay neareft to it. An cedematous tumour, in
the mean while, had occupied the whole leg and thigh of that fide. As the
patient, however, had a good appetite, and ate very plentifully, and the tu-
mour confequently increas'd, a very unfkilful furgeon took upon him to be
of a quite different opinion from Vallifneri; and not only to apply fuch things
as tended to bring on a fuppuration, but even, when, from the ule of thefe
things, vefications and chops had appear'd in the ikin of the loins, to make
an incifion therein. This incifion was follow'd, on the fucceeding night, by
a rupture of the tumour, which brought on an immediate profufion of blood
to a very great degree •, the confequence of which was a lofs of ftrerrgrh and
voice : lb that within a quarter of an hour after the rupture, he departed ^his
life. On the day following, which was the fifth of November, in the year
1720, Vallifneri related thefe things to me, and beg'd of me that I would be
prefent at the diffection, together with him, which was perform'd by our
Vulpius.
The abdomen being open'd, the aneurifm came into fight, a larger than
which I never faw. It almoft occupied the half of the abdominal cavity, be-
ing plac'd longitudinally. For extending itfelf from the diaphragm to the
pelvis, it took up all the fpace that there is from the right fide of the vertebras,
to the left fide of the diftended abdomen •, the fpleen, the ftomach, the in-
teftines, the mefentery, the vena cava, and the left kidney, being lb far
driven towards the right fide, that even this kidney lay in the umbilical re-
gion. The aneurifm was then of an oval figure : when fill'd with blood it
had, without doubt, been of a fpheroidal figure : yet it was, even then,
ftufT'd up with a very great quantity of blood, which had concreted round about
into polypous laminas •, but was fo far ftill grumous in the middle, as to re-
iemble the confiftence of a pultice. And after all this was taken away, we
then obferv'd the following; thing-s.
The aorta, where it firft came down into the belly •, as it began, in that
part, to be immediately dilated in an anterior direction in a fmall degree,
and towards the right fide ; not more than fo as to admit of a clench'd fiftot a
moderate fize ; expanded itfelf fo much to the left fide, that it feem'd to make
up the anterior and lateral parietes of the defcrib'd aneurifm : which, in that
part, communicated largely with the cavity of the aorta, betwixt the ap-
pendices of the diaphragm.
The lateral parietes, when they had come to the pofterior parts, immedi-
ately terminated there ; and their termination was very clofely agglutinated to
the parts which the aneurifm had not remov'd from thence : for which reafon
there was no peculiar pofterior paries to the aneurifm •, but the very parts
themfelves flood in the ftead of a paries. And of thefe parts, thofe which, by
reafon of their bony nature, could lefs yield to the ftrokes of the in-n.lhing
blood, were themfelves, alio, affected with a caries, the periofteum being
eroded ; that is to fay, the lower rib, and the hollow lurface of the os ilium :
and the vertebras were in a ftill worfe ftare.
For the tranfverfe procelfes of the lumbar vertebras, on the fame left fide,
were either already broken through by caries, or could be eafily broken by
4 a flight
Letter XL. Article 27. 439
a flight preffure of the finger alone : and the bodies of the lowermoft ver-
tebra of the thorax, and the two lumbar which lie nearcir. to that, were l.ol-
kow'dout to a verv great depth, and in great mealure conium'd; which cir-
cumilance the more readily OCCUr'd to the eye, becaufe thole thick cartilaginous
ts that lie betwixt the bodies of the vertebrae were, even then, all in
their proper iiruation, prominent, untouch'd by diieafe, and of a beautiful
whitenefs : and the deprefjion made by the deilruction of the vertebras, ren-
der'd their prominences more ftriking ; as, on the other hand, their promi-
nences better IhowM us how much the vertebras had been confum'd. All
thele things, therefore, which came immediately into view, upon taking away
the blood, being fufficiently examin'd ; we turn'd our eyes to the vilccra or*
the belly, and were furpriz'd to find them all found, in fpite of fo great an
inverfion of their order.
In the thorax alio, we found nothing preternatural, except that the peri-
cardium contain'd a little more water than it generally does. For as to the
lungs appearing to be very white, juft as if the blood had been wafh'd out
of their veffels, by frequent injections of water ; this we did not doubt was ow-
ing to the blood flowing into the ruptur'd aneurifm, where there was no refill -
ance, in the latter part of life.
27. Many things which I might have obferv'd, in regard to this very large
aneurifm, I purpofely omit ; and thofe things, in particular, that I hinted at
before, when I was fpeaking of other aneurifms. I choofe rather to obferve
two things here, one of which you will have in the latter part of this let-
ter (a) ; and the other relates to the fufpicions of aneurifms, after pains of
the back and loins •, which have been equally troublefome, and long-conti-
nu'd ; that were not found out in the living body, at one time •, and, at an-
other time, what is (till more furprizing, even in the direction of the body
after death.
To fpeak firft of the latter: read over again, very attentively, fome hifto-
ries that are transfer'd into the Sepulchretum, in more than one fection ; and
even into this twenty-lecond : that is, under obfervations the thirty-fifth and
fortieth. You will fee that after pains of this kind, which were, at length,
fucceeded by a fudden death, in one of them " two vertebras of the loins were
u found to be corroded •, one with a rupture of the aorta, and vena cava,
" under which they lay ; and that, by this means, a great effufion of blood
" had been made into the belly, from both of thefe veffels :" and in the
other, you will read that there was found " a kind of putrid, blackifh, and
44 corrupt flefh," which had fo eroded the fpine, in the abdomen, " to the
" length of two fpans, and to the breadth of two hands, as to make it con-
*' tain an ulcer of a cancerous nature, of the bignefs of a man's fift ; and
" that the whole of the fpina dorfi could be eafily broken by a flight itroke :
" and, finally, that it had, at laft, alfo, corroded the vena cava itfelf, where
" it ran down upon the fpine ; the blood of which, by getting through the
" diaphragm, that had been perforated by the fame putrid flefh, had ob-
" ftructed the motion of the lungs, and brought on death."
(*) N. 30.
The
440 Book III. Of Diieafes of the Belly.
The firft of thefe diforders is i'uppos'd to have been the tabes fpi .
defcrib'd by Hippocrates : the fecond, a very large and putrid tumour of the
pancreas. And although I do not deny this, 1 nevertheless fufpect the moft
conliderablepart of the tumour to have been from a dilatation of the large vef-
Ills. Nor am I altogether without a fufpicion of this kind, when I, foon af-
ter, read in the fecond forty-fecond obfervation ; for the number is repeated
through careleiTnefs •, when I read, I fay, that after a conflant and long-con-
tinu'd pain, about the region of the os facrum, there was found, " about
44 that region, in the part where the vena cava is bifurcated, a large abfeefs,
44 in which was contain'd a foetid matter, and a coagulated blood." And
*allo, " that the os facrum was lb corroded, and deftroy'd, in this part, that it
44 could be very eafily drawn out, and rub'd into pieces, with the fingers."
But I fhould fuppofe there was ftill lefs danger of my being deceiv'd, in my
fufpicion of the obfervation, which is the firft in the Additamenta to the twelfth
fection of the fourth book. For therein we read of a man, who had been
long afflicted, with violent pains of the whole fpina dorfi, and who was found,
about a quarter of an hour after having din'd with his family, lying upon the
-ground, and dead-, the fpina dorfi being broken afunder, which they fup-
pos'd to have, probably, happen'd to him, while he ftoop'd down to lay hold
•of the chamber-pot. From the belly, when open'd, a great quantity of blood
immediately burft forth, wherewith the whole cavity of the thorax, on the left
fide, was fill'd. And there was, likewife, a very large tumour, which reach'd
from the fixth vertebra of the back, quite to the firft of the loins, and which
" appear 'd to be fill'd with a very great quantity of flefh, of a cancerous na-
" ture, macerated in its fubftance, and cover'd over with a fmall quantity of
44 pus, and coagulated blood." The tumour was contain'd in 4' a very
44 ftrong membrane, that had obtain'd the thicknefs of a crown-piece, but
44 was torn near to the firft vertebra of the loins ; which was, in part, defti-
44 tute of its perioftium : lb that the two laft fpurious ribs no more coher'd
•*4 tathe fpine." Moreover, 4' the fix inferior vertebras of the back, and the
44 firft of the loins, were entirely deftroy'd by a caries, as if eroded by
44 worms •, fo that, in this place, the fpine was without any folidity, or
-" ftrength," and, for that reafon, eafily broken through. " The diaphragm
44 itfelf was perforated fo as to admit of two fingers join'd together. The
•4 emulgent vein of the left fide was alio torn afunder."
I could wifh any mention had been made of the great artery, as is made of
this vein •, as that artery muft have adher'd to all thefe rotten vertebras: for
from thence I might either have confirm'd or rejected my fufpicion. You
have feen that, in my obfervation (£), the vertebras were very deeply hol-
low'd out ; and, in one of the obfervations refer'd to, fo corroded, that the
fpine might be broken with a flight ftroke : and in this laft you fee that it
was really broken after erofion. And you perceive what I may fufpect from
mine. But this is beyond fufpicion, that from a large aneurifm adhering to
the fpine, this mifchief may, btfides others, be brought on •, I mean that the
fpine may be broken ; for there was not much wanting to compleat this acci-
dent, even in our carman.
{/>) N. 26.
How-
Letter XL. Article 27. 441
However, left you fhould fuppofe all my fufpicions to relate to thofc ob-
feivations only, that are oxtant in the Sepulchretum •, at leaft turn to that
which being publifh'd, amongit others, by a very eminent man, many j
after the fecond edition of this book ; or rather, which being (as far as 1 can
underftand from the Acta Helvetica (f), wherein the fame hillory is) newlv
fbrm'd by him-, tells you that there had been a very conliderable tumour in
the fide of the loins, and the left hypochondrium, " from a very large glo-
'* bular, and tenfe body, occupying almolt the whole fide of the abdomen •"
which, when cut out, and ruptur'd, " pour'd out a great quantity of bi
" cruor, wherewith it was fili'd, of a yellowifh fubttance, fpongy, and form'd
" into lamellae, that lay one upon another."
But as the left kidney adher'd externally to this body, which was itfclf fitu
behind the left tract of the inteltinum colon, within the duplicative of tin >
ritonanim, and even, in lb me part of it, " penetrated into that bulbous body-,"
it feem'd that this fame body was a part of the kidney ; that is to lay, a pare
enlarg'd to an incredible degree. I, however-, which I take the liberty to lay,
with a defire of finding out truth, and not with a defire of cliflenting
from others ; fufpect it to have been an aneurifm, not only from its fitua-
tion, or from the concretion of the blood therein, in fo large a quantity,
and the formation thereof into lamellae, lying one upon another; but, final
ly, from this circumftance alio, " that a living animal was fuppos'd to exift"
in the man's belly, while living ; which feems to argue that fome puliation
was perceiv'd : and I fuppofe that the aneurifm had, by its increafe, vitiated
a part of the neighbouring kidney.
Not much unlike this fufpicion of mine, was the judgment of the cele
brated NebeliusCi), in regard to a roundifli tumour ; which, being annex'd
to the left kidney, had been laid " to confift, internally, of a great number
" of coats, and to be fili'd with blood and tartareous matter : for he thereby
knew it to be an aneurifm of the emulgent artery. And, indeed, he has ad-
ded the cafe of a celebrated phyfician, which may, in great meafure, be com-
par'd with that which was juftnow confider'd by me. For the fame left fide
being affected with pain, at firft of the nephritic kind, and after that of the
rheumatic, as was fuppos'd ; and the phyfician being fuddenly carried off, up-
on the pain having become more violent all at once; it was found, that the
blood, which had been difcharg'd into the belly in great quantity, had pro-
ceeded from the ruptur'd aneurifm, which protuberated in the fame fide of
the belly, under the annex'd inteftinum colon ; being equal in magnitude to
the head of a child of three years old. And " in this hollow tumour, when
" cut into, which was diftinguifh'd with internal membranes, and fili'd
" with coagulated blood, adher'd the left kidney in a putrid and flaccid-
" ftate."
But while I take notice of thefe things, I would not have you fuppofe
from hence, that I am quite a ftranger to thofe internal abfeefies, whereby
not only a pain of the loins, os facrum, or fpina dorfi, may be excited, but a
caries of the vertebra alfo may be brought on. For 1 know, to refer to thofe
I have read of in the more modern books, that abfeeffes have been found in that
(<-) Tom. i. (d) Eph. n. c. cent. 9. obf. 59.
Vol. II. LI 1 part
442 Book III. Of Difeafcs of the Belly.
part of the melbcolon, which many call the meforectum (a word that is un-
learnedly compounded) in thofe whofe fymptoms •, and among thefe " pains
" within the os facrum;" are accurately defcrib'd in the Commercium Lkte-
rarium. I know, likevviie, from the A els of the Casfarean Academy («?), that
they have been attended with pains of the loins, and back •, in whom, after
death, large internal abfcefTes were found, together with a blacknefs, either
of the lower lumbar vertebras, and a caries, which had broken down one
half of the os facrum into little pieces-, or a fimilar diforder of the firft lum-
bar, and the laft thoracic vertebra.
Yet I cannot forget either the merchant, who having labour'd a whole year,
under a very great pain of the fpina dorfi, had an aneurifm, as Ballonius (f) has
aflerted, in the aorta, where, lying upon the vertebras of the loins, it is di-
vided into the ilacs ; or that nobleman who had been afflicted with a very
violent pain of the back, in whofe aorta was, likewife, found an aneurifm,
agreeably to the diagnofis of Vefalius, which I have already commended (g),
and which was really furprizing at that time, though eafily imitable now ;
and that not without a caries of the neighbouring vertebras, and a diforder of
the ribs. And as long as I fhall call to mind thefe, and other examples like
thefe, which have frequently offer'd themfelves to others, and to me alfo, I
cannot help fearing (where defcriptions of abfcefTes of this kind, found in
thofe places occur, fo as to leave the mind in fufpenfe) left an aneurifm mould
have lain hid under the name of an abfeefs.
Thus far of fufpicions in differed bodies after death.
28. And in regard to thofe which have happen'd to me in living bodies •, to-
omit others •, I will mention two patients, to whom I myfelf had alfo given ad-
vice, when I was in the place of my nativity, againft violent and obftinate
pains of the loins and back. The one was a brazier, by name Peregrini.
And this man (as I heard after coming here to take upon me the profeflbr-
fhip) had (till continu'd to be afflicted with his pains, till he, at length, died
luddenly, which was an event but little expected by the phyficians : fo that
my fufpicion was confirmed, of thefe violent pains having their origin from
an aneurifm of the aorta, where it defcends in the courfe of the fpine-, and
there is no doubt but his fudden death was from the rupture of the aneurifm.
But the other was a nobleman, by name John Anthony Corbiceo, who
was fnatch'd away by a fimilar fate, when it happen'd unluckily that I was-
abfent-, otherwife I might have had the liberty of diffecting the body, which-
1 ihould much have wifh'd. For I fufpected an aneurifm in him, fo as, at the
lame time, to fear left a vomica might lie hid in the liver, of which, when-
ruptur'd, a fpeedy death would be the confequence. And, indeed, there
were many marks, and thofe not obfeure ones neither, of the liver being af-
fected •, but with thefe, neverthelefs, were prefent, and even had preceded a
great part of them, and perhaps all, fuch pains of the loins, as are not
wont to be join'd with a vomica of the liver. It is, perhaps, worth while to-
relate the whole hiftory to you here with accuracy, efpecially as I have pro-
rnis'd it to you before (h).
(e) A. 1742. hebd. 20. n. 3. (g) Epift. 17. n. 3.
(/) Paradigm. 1.3, (£) Epift. 36. n. 6.
This
Letter XL. Article 28. 443
This gentleman was fixry years of age, tall in Mature, of a large mufculai
body, his face being red from imall fubcutaneous veins, which were here and
there confpicuous ; but particularly at the lower part of the nofc. The flux
or' blood from the hemorrhoidal vein- ; which us'd to return at intervals, and
without any injury to the conftitution •, having been dimimfh'd now for a
twelvemonth, and uneafy affections of the mind coming on, his body began to
belbmewhat emaciated, before the beginning of the (bring, in the year 1710.
And foon after, as he was riding in his chariot, as his cuftom was then, a
pain difcovcr'd itfclf in each of his loins, and that part of the (bine which lies be-
twixt them : in which parts it had been before obfeure only, and not conllamly,
but fomedrnes. Now, however, it not only continu'd, but, being incn
about the beginning of April, and grown much more fevere before May, was
very troublefome to the patient, efpecially when he was fitting, or lying down ,
and Hill more when he endeavour'd to turn himlelf in the flighted manner •,
or upon bending his body, and raifing it again ; or when he role from
his bed.
It was thought proper, on account of thofe things which I have faid of
the hemorrhoidal Mux, and, in like manner, on account of the blood, which,
in the preceding months, had flow'd, more than once, fpontaneoufly from the
noftrils, that blood fhould be taken away, firft from the arm, and after that
from the piles •, care being previoufiy taken that the belly, which was then
coftive, fliould be relax'd. Opening the belly was of great ufe to the patient,
as the firft bleeding was alfo ; fo that the pain now feem'd to be quite re
mov'd. But the furgeon, neverthelefs, having, without confulting any phy-
fician, applied leeches to the piles, which he found to be very turgid, fo
great a quantity of blood was fuddenly difcharg'd, that, not long after, there
appear'd marks of the habit being much weaken'd and deprav'd. Being,
therefore, fent for again, after the middle of June, I not only heard what I
have already related to you, but other circumftances alfo. For it was now
more than twenty days from the time that a jaundice had appear'd, . with an
cedematous fwelling of the feet : at firft he could get no fleep ; his appetite
for food was loft ; and he had a languid fenfation of the ftomach after din-
ner : but now this fenfation was quite remov'd, and his fleep and appetite
alfo, though the latter in part only, had return'd fince the time in which he
firft began to take the remedies that were given him againft the jaundice:
and among thefe remedies it had been obferv'd that rhubarb, though very
fparingly given with currants, had increas'd the laflitude •, not fo much be-
caufe it purg'd much by ftool, as becaufe it exacerbated the pain in the laft
lumbar vertebra, and the bafis of the neighbouring os facrum. For the patient
complain'd much of this pain being a great fatigue to hirrij and aflerted, that
it was much more troublefome, if he, at any time, walk'd through his
chamber.
It chagrin'd me very much, that the pain, which had been fuppos'd to
be entirely remov'd, fhould have not only return'd, foon after it feem'd to
have ceas'd, but fhould become more violent every day. Yet I was ftill
more difpleas'd with other fymptoms. For I obferv'd that the pulfe of the
patient was frequent, and fomewhat hard ; his refpiration now and then deep,
ard difficult, as it were; his feet, and the lower parts of his legs, but parti-
L 1 1 2 cularly
444 Book III. Of Difeafes of the Belly.
cularly the foot and leg of the right fide, were fomewhat fwell'd, and pre-
ferv'd the marks of p refill re, after the finger was applied to them : his (kin
and his eyes were yellowifh ; his urine, and his eyes alio, were obferv'd to
be more yellow in the day-time, and what was the worft of all, when I ap-
plied my hand to his belly, 1 found, on the right-fide, under the very arch
of the lower ribs, the liver fwell'd to the fize of a kid's head, and hard be-
sides ; but without pain. While I was feeling this tumour, the pat'ient faid
that he had obferv'd it for the fpace of three years, though not to be fo large,
as he had, alfo, fome yeHovvnefs in his eyes ; and yet, fays he, you all very
well know that I have always had good health till this year.
Having very cautioufiy determin'd, in conjunction with his phyfician, up-
on fuch remedies as feem'd moft proper at that time, I went to fee the pa-
tient again a third time, before the middle of July, in order to confult with
the fame phyfician, and with Albertini, who had been fent for from Bologna.
At this time, however, the cedematous fwelling of the lower limbs was en-
tirely vanifh'd, I fuppofe becaufe the patient lay in bed for the moft part : he
had a good appetite for food, and his ftomach feem'd to perform its office
very well. But he was troubled with watchings in the night : his pulfc was
more frequent in the evening, though it was pretty much fo in the morning-,
it was much larger than it had been before, and not without fome impetus :
he had a thirft : his tongue was very dry, and ting'd with a red colour, in-
clining to blacknefs : the fkin was not yet without yellownefs, although the
ftools were not, nor had before been, of a white colour : his urine was even
then of a faturated colour, but thin : the tumour of the liver, in which there
had been pain, fometimes, fince my having fcen the patient, though it had
been readily appeas'd, might at that time be felt without pain, unlefs any
one handled it for a long time, and fomewhat roughly ± for then fome pain
arofe in the lower edge of the liver.
Albertini, while he was examining this tumour with his hand, thought he
could obferve fome inequality, juft as if the furface of that vifcus was made
rough, with a kind of pretty large granules ; and from hence he conjectur'd
that the tumour was inclin'd to a fcirrhous nature, in confequence of the
glandular bodies, as it were, of the liver being diftended by the concreted
biie : yet, by reafon of the pain, he was afraid left the nature of the tumour
fhould be different in fome other part. When he had, in conjunction with
us, approv'd of fuch things as it became a very cautious phyfician to approve
of, and had return'd to Bologna •, and I was gone to a diftant place to attend
the cure of a patient there ; it fuddenly happen'd that this patient •, who had
not only feem'd to be no worfe in thofe days, but on the fourth from our con-
futing together, feem'd to thofe about him, and in particular to himfelf, to
be much better ; having got up to take his fupper, at the firft hour of the
night, was feiz'd with a kind of troublefome fenlation of his ftomach, and of
the affected part ; his face being, at the fame time, cover'd all over with a
told fweat, his lower limbs very cold, and his belly very tumid.
He was already laid in bed again, when the phyfician, who had been fent
for in hafte on this occafion, found, befide the other circumflances, a pain
of the whole epigaflrium, a reaching to vomit, a low and languid pulfe ; his
voice and his femes being weak, and his face like that of a carcafe. There-
5 fore,.
Letter XL. Article 29. 445
fore, at the eighth hour from the beginning of thefe fymptoms, death cann-
on. Muft we ftlppoft this to have happen 'cl from an abfeefs of the liver being
ruptur'd, as moft of the fymptoms, but not all of them, leem to (how ? Or
muft wc fuppofe it to have been owing to the rupture of a fanguiferous vcf-
iel ?
Albertini himfelf; who had lately obferv'd all the circumflances which fell
tinder his examination, with great accuracy, according to hiscullom, and had
enquir'd into the others, and did not know of any more belides thole which
I wrote to you of juft now •, having receiv'd an account, in a letter from m< ,
of the death of tins man •, though he naturally conjectur'd that fomething
had been ruptur'd, by the motion of the patient in riling, and that a great
quantity of fluid was extravafated into the cavity of the belly •, yet he dcclai'd
that he could not fowell conjecture what it was that had been ruptur'd. Bun
if fome marks of a fuppurated tumour, and among thefe, what he chiefly
requir'd, rigors, and fhiverings, had preceded •, none of which certainly had
ever happen'd-, he then confefs'd, that he fliould, without hefltation, have
accounted for the circumftance from a ruptur'd vomica of the liver. There-
fore, if, in any part of the liver, any tumour had happen'd ro come flowly
and latently to iuppuration, that he fufpected the hidden death Was not fo
much to be imputed to the rupture of that fmall part, as to the rupture of
fome contiguous blood-velTel, which had been injur'd by the pus. Yet by
this fufpicion, that old and obftinatc pain in the vertebrae was not explain'd,
mention of which I do not remember to have feen made, in the great num-
ber of hiftories of abfeeffes of the liver, that I have confider'd ; and befides, that
tumour, which we had touch'd, with our hands, was far diftant from the
vertebrae: and the lower edge of the liver, where I have faid the pain had
been for the moft part, of late, was ftill more fo.
Nor is there any colour for our fuppofing the pain, which was extended to
die lower vertebrae, in particular, and the bafis of the os facrum, to have
been owing to the trunk of the hasmorrhoidal vein 5 the roots of which we have
faid were fo turgid ■, for after that great quantity of blood being difcharg'd
thereby, they were certainly no longer turgid : and when they were the moft
turgid, it had, even then, happen'd that the pain fcem'd to have been re-
mov'd, though for a fhort time. But if an aneurifm of the aorta, where it
goes down upon the vertebrae •, of which I have fome fufpicion, befides the
tumour of the liver ; does not feem to you to be fuch a difeafe, that the ef-
fects of it could be lb far oblcur'd, even for a fhort time •, and that cannot be
conceiv'd to exift without many other, and confiderable fymptoms ; 1 beg or*
you to determine nothing on the queftion, before you have read the obierva-
tion which is here mbjdin'd.
29. An old man, who was formerly fuppos'd to have been diforder'd from
the lues venerea, had already lain many days in this hofpital, complaining"
of every thing, but what couid refer to that lues, or to a large internal an-
eurifm •, and certainly, for t enquir'd with the greateft care, Was neither
troubled with pain, nor a i'enfe of weight, nor- a difficulty of breathing. He
died a little after dinner, and that fuddenly, about the middle of December
in the year 1718.
The belly being open'd, and the urinary bladder taken away, together
with the penis; for I was at that time bufy in obferving fome things that re-
late.
446 Book III. Of Difeafes of the Belly.
late to thofe parts; the urethra confirm'd the opinion of that okl lues. For
it was, in feveral places, full of fears, and the feminal caruncle itfelf was
not in its natural ftate of conformation •, lb that it was not eafy to demonstrate
the two very fmall orifices, into which it is perforated laterally, nor the orifice
of the finus, which lies betwixt them. To thefe were added fibres, diftinft
from each other, and prominent-, from which fomething like a fmall triangle
was form'd, the bafis whereof was very near to the bladder, while the ver-
tex touch'd the caruncle.
The vifcera being then remov'd, a large aneurifm of the great artery came
into view •, refembling a crefcent in its figure, the back of which was plac'd
tranfverfiy under the annex'd diaphragm, while the horns were turn'd down-
wards, and were hid behind the pfoae mufcles on each fide ; the left horn
fo far as to reach to the lower third part of the mufcle ; but the right did not
come down lb far. This aneurifm, likewife, had no pofterior paries ; where-
fore, taking away the blood with which it was fill'd ; and which had been,
in great meafure, form'd into polypous laminae, lying one upon another •, the
bodies of two or three vertebras, that belong'd to the lower part of the thorax,
and the upper part of the loins, immediately appear'd : thefe vertebrae were
naked, but deeply eroded ; the white and cartilaginous ligaments being here,
alfo, protuberant betwixt body and body, and, to appearance, untouch'd by
difeafe. But this aneurifm had been ruptur'd, in its upper part, on the lefc
fide ; fo that the blood, where the diaphragm had given way, burft forth, from
the fame fide, into the cavitv of the thorax, which it had almoft univerfally
fill'd.
30. You fee, then, how obfeure the figns of fo large an aneurifm were in
this cafe ••, though it is not to be doubted but fome mult formerly have pre-
ceded, and particularly pains of the loins.
But if you compare this obfervation, and that made upon the carman (7),
with other obfervations of aneurifms in the aorta, whereby the neighbouring
vertebras were corroded ; you will, perhaps, be furpriz'd at one thing, I
mean, that the ligaments lying betwixt thefe vertebrae had appear'd to us to
be untouch'd : which other writers of thefe obfervations, as far as I can at
prefent remember, have not taken notice of. And indeed fome of them
htfve exprefly laid that thofe ligaments were found to be hollow'd out, and
confum'd, no lefs than the bodies of the vertebrae ; as, for inftance, the cele-
brated Vernojus (£), and the author of the laft figure but one, in the memoirs
of the Royal Academy of Sciences at Paris, for the year 1714, whereby this
is clearly fhown.
And indeed that cartilages are then liable to consumption ; whether this
happens from the frequently repeated ftrokes of the blood, rufhing into the
aneurifm, or from the eroding particles, as I have already explain'd (I) -, is
ihown by the obfervation of the celebrated Maloet, given us in the fame me-
moirs, for the year 1733 ; wherein fome cartilaginous fegments of the afpera
arteria, which ferv'd in the ftead of a pofterior paries to the aneurifm, were
found to be become already very weak, and lefs convex than natural; and two
of them, in fome meafure, confum'd. And as I have fpoken to you of this
{*) Supra, n. 26. (i) Comment. Acad. Sc. Imp. Petropolit. torn. 6. (/) Epift. 18. n. 17.
obier-
Letter XLI. Article i. 447
obfervation before (;a); I alio there faidj at the fame time, that the foftcr
parts were lefs worn clown than the more firm and folid, as they gave
lels refiftance to the ftroke ; but here I do not Tee that the fame explication
can be admitted or.
For if 1 lav that the ligaments, which lie betwixt the vertebra', give lels
refiftance than the vertebra-, and for that realbn fuller lefs attrition alio ; yon
will immediately alk, why. then were they not found in the lame Hate in
others, as they were in thole two men whom I defcrib'd •, but in the one con-
fum'd, in the other untouch'd ? Ifthefe, in whom they were untouch'd, had
been both of them young men, and the other old, it might perhaps have
been anfwer'd, that in the former thefe ligaments gave lefs refiftance, and in
the latter more. But not to infift upon the other examples ; as 1 certainly
may upon that given by Vernojus, which is from a young man ; even the
firlt of mine is from a young man : lb that it does not appear why they
fhould be deftroy'd in the former, and not in the latter •, nor yet why they
il-iould not be deftroy'd in the old man whole hiftory I have given. The ob-
fcure caufe, therefore, of this difference •, whether to be accounted for from
the different nature of the eroding humour, in different bodies, or from any
other caufe; I leave for you to inveftigate : for this letter is already fuffi-
ciently long. Some days hence I (hall fend you another •, but in the mean
time I wifh you much health.
(w) Epiit. 21. n. 48.
LETTER the FORTY-FIRST
Treats of the Suppreilion of Urine,.
ALTHOUGH the total defecl: of a urinary difcharge happens either.
from a diforder of the kidnies and ureters, or of the bladder itfelf, and
urethra J yet it has never happen'd either to Valfalva, or to me, to difiec~t
the bodies of thole who died from the former caufe only. Nor is it to be
wonder'd at, fince the kidnies and ureters are double •, fo that if their office
fhould happen to be fufpended in one fide, the defedt is fupplied by the other.
For what is believed by many is not always true, that when either of the
kidnies is inactive, the other is inactive, alfo, at the lame time : which opi-
5 nion
448 Book III. Of the Difeafes of the Belly.
nion is rejected in the foregoing letter {a) : and you will even find fuch a
number of obiervations, in the twenty-fourth fection of the Sepulchretum
(Z-) (whereto this letter relates) which may be added to the obfervations I
have pointed out in the preceding; that, if you compare them with thofe of
the urine being fupprefs'd from a diforder of one fide only, you will be very
clearly convine'd that thele latter obiervations are much more rare than the
former.
For thofe of the firft kind will be met with in feveral places •, not to men-
tion where Gerard Blafius (V), Ifbrandus Diemerbroeck (d), Ludovicus Me*-
catus (<?), infill upon this kind as being the mod frequent : and if you would
choofe to add thofe which have fince come out, in the volumes of the Cx-
farean Academy (f), you would certainly find none which did not relate to
the fame kind ; that is to fay, both the kidnies being either feiz'd with a
fphacelus, or, even, as Rudolphus Jacobus Camerarius faw (g), being af-
fected with an unufual lofs of tone, and flaccidity, or ftuff'd up with cal-
culi : or if one of them did not labour under the fame diforder, at leaft con-
fum'd, and inactive-, or its ureter obstructed with land and calculi.
But the obiervations of the other kind, that is of the urine being fupprefs'd
on account of the diforder of one fide only, in the cited fection of the Sepul-
chretum, amount but to few •, and fo much the fewer, becaufe one of them,
as that which is read under the nineteenth article of the firft obfervation, does
not belong to this clafs, as it, at firft fight, feems to do : and this we may
clearly gather from the fame hiftory, when more fully given, not only in the
twenty-fecond fection, under article the firft of the thirteenth obfervation,
but even in this very fection, under the fourth article of the firft obfervation ;
fo that there was no occafion to repeat mutilated obfervations in particular,
not to fay, to repeat them a third, and even a fourth time : for what we have
under the twentieth and twenty-fecond articles, of the fame firft obfervation,
although they may feem to be different, by reafon of the name, and number
of days, being chang'd through neglect •, yet that it is the very fame, appears
from infpecting the third fection of the firft book, under article the firft of
the fifteenth obfervation ; and in like manner under article the firft of the
thirteenth obfervation, of the twenty-fecond fection which Ijuftnow quoted,
of the third book. And I could wifh this hiftory was the only one that is re-
peated in that twenty-fourth fection, of which I have begun to fpeak.
But you, by comparing article the eleventh of the fecond obfervation,
with article the ninth of the fourth ; and, in like manner, the eighth obfer-
vation with article the fourth of the tenth (b) •, and article the feventh of this
laft, with the eleventh obfervation •, and to return to the firft, and fecond ob-
fervation, by comparing article the fecond of the former, with article the
twenty-firft; or article the third, which is improperly mark'd the firft, with
(a) N. 15. obf. 55. & 56 ; Si act; torn. 2. append, n. 3. &
(b) L. 3. torn. 3. in obf. 6.
(c) Obf. 1. §. 9. {g) Specim. experim. circa general, part.
{d) Ibid. §. 10. therap. in refolut. hift. 3.
(e) Obf. 2. §. 1. (J)) Primam de duabus intellege eodem n. x.
(/)Dec. 3. a. 4. obf. 60 ; a. 7 & 8. obf. 147 ; dehgnatis.
\j * j - -r — » — / -- — ri '
a. 9. & 10. obf. 95 ; & cent. 5. obf. 22. cent. 6.
article
Letter XLI. Article 2. 449
article the cwejity-feventh •, and, in like manner, with article the fecond of the
fecond oblcrvation •, you will immediately perceive how much better it would
have been to have given them only once'-, or, if the authors themlelves had
written their own obfervations more than once, and, for that reafon, not always
in the lame words, to have added the fecond manner of writing it immediately
under the other, if it feem'd a thing of importance to do it.
There are, however, in this fection ibme hiftories of the fecond clafs alfo, as
under oblcrvation the firlt," article the fourteenth, and under oblcrvation the
third, article the firlt, fecond and third ; and if you pleafe, moreover, under ob-
fervation the fourth, article the fecond. But what arc thefe to the far greater
number of the firlt kind ? Which is increas'd by lbme others, that you meet with
in the additamenta to the twenty fourth feclion : for the obfervations, given in
this fection, ought to have been added, in the greater part of them, to the
preceding feiflion, and befides this, others are omitted, even thofe that are
molt obvious ; as, for inltance, that which had been given us in the Centuria
of Ruyfch (i). It is certain therefore, it happens much more rarely that a
fupprcflion of urine is brought on by a diforder of the kidnies and ureters,
which are double, than by a diforder of the bladder and urethra, which are
unduplicated parts : and for this reafon it is the lefs a matter of furprize, that
I have not yet had it in my power to diflect the bodies of thofe who have
perifh'd from an obstruction of thefe firlt- mention'd parts.
2. And I have been Itill the more defirous of diffections of this kind, that I
might have an opportunity to examine thofe parts, in thefe bodies, from
whence, through which, and to which, different authors take notice of diffe-
rent peculiar paffages of the urine. For although I have propos'd an argu-
ment againlt thefe paffages, in the adverfaria(£), taken from thofe circum-
ftances which, it is very certain, have been obferv'd in fiippreffions of urine
happening from a diforder of the kidnies •, which argument has feem'd to
me of fo much the more weight, fince I have obferv'd, that it was very plea-
fing, not only toothers, afterwards, but even to Boerhaave (/) himfelf: yet I
wifh'd more fully to fatisfy a certain celebrated man, who thought that thefe
peculiar paffages terminated in the pelves of the kidnies, and that neighbour-
hood, as many believ'd even before : fo that, although the kidnies only are
feen to be obltructed by calculi, or any other impediment of this kind, yet,
for that very reafon, the mouths of thefe paffages may, at the fame time, be
comprefs'd, and tranfmit nothing, at that time into the pelves, or the neigh-
bouring; ureters.
You therefore, when you lhall be furnifh'd' with an opportunity of differ-
ing bodies of this kind, will, I hope, do what I intended to have done;
that is to examine, with the greatelt accuracy, all the membranes which are
bordering upon, or connected to, thofe parts; for if* the mouths of thefe
paffages are comprefs'd, it cannot be but the remaining tract of them mult
be fo much the more diltended with the Itagnating fluid, in proportion as the
orifices, which emit this fluid, are more fhut up ; efpecially as the offices
which they afcribe to thefe parts require, and even they themlelves readily
allow, thefe paffages not to be very fmall : although it feems, from one cir-
(■'") Obf. ie. . (}) Prxlca. adlnfth. §. 385.
(/.-) HI. Animad. 36.
Vol. II. M m m cumftance,
450 Book III. Of Difeafes of the Belly.
cum (lance, as if your labour would be in vain; I mean from this, that we
never read of theic paflages having appear'd to any one in cafes of this kind,
notwithdanding a great number of bodies had been taken in by fuch perfonsr
which mud, of courfe, have di (tended thefe, or any other paflages, that have
been fuppos'd, by others, to lead to the bladder ; and notwithstanding very
accurate and experiene'd diffecters examin'd the bodies after death.
For Francilcus Plazzonus -, to ufe the example of that hiftory which I have
mown to be three times repeated, in this feet ion of the Sepulchretum (tn) -T
either diflfected himfelf, or was prefent at the direction of, that monk, to
whom, among other diuretics, even cantharides had been given ; which had
ulcerated the bladder, although empty : fo as to convince us that the virtue
thereof had reach'd thither by means of the fanguiferous vefTels, and not by
any peculiar unknown paflages -y which, together with this virtue, would have
transmitted the diuretic potions, at the fame time, either into the pelves of the
kidnies, or ureters, or immediately from the (lomach into the bladder. For
this fecond opinion was embrae'd by many, either, perhaps, on account of thefe
words of Hippocrates (n) ; or at lead, of a very ancient author ; " if a child
" (hall have veins going from the (tomach to the bladder which are lar^e,
" and have a power of attraction," or rather on account of thefe things
which they had heard of, as happening in a true diabetes, very extraordinary
examples of which you may read in Marcellus Donatus (o) ; I mean " that
" what is drunk mould be difcharg'd by the urinary paflages, without the
" lead change whatever, preferving the fame colour, confidence, tade and
" fmell," as when taken in.
But if it is necefTary, for that reafon, to fuppofe duels going from the do-
mach to the bladder ; it would be necefTary to fuppofe others going to the
fkin, as to thefe examples, Donatus has made no lcruple to fubjoin this, alfo,
of a very liandfome girl, who had been for a long time afflicted with fevers, in
whom "the fluids, that die drank down, were difcharg'd from the precordia
" by fweat, before the cup was well taken from her mouth ; and that in the
" fame quantity in which they had been taken in, and without any altera-
*' tion •, fo that from red wine, the linen, with which (lie was cover'd, was
" ting'd with a red colour •" and " from white broth, in like manner, with
" a white colour ■" and that this had been obferv'd " for the fpace of two
" weeks.** Yet in regard to thefe unknown ducts ; by what way foever they
may be fuppos'd to pafs from the domach to the bladder, or urinary paflages ;
I remember that the celebrated Pada very judly obferv'd to me, formerly, in
a letter, that if there really were'fuch paflages, it mud, of courfe, have hap-
pen'd to thofe who abufe quickfilver, in our country as well as others, fo as
to take near an ounce every morning, that fome part of it, at lead, would
have been difcharg'd with the urine •, which, however, had by no means been
obferv'd, by our phyficians, in any one of thefe perfons.
But if you fhould fay, that thefe ducts are fcarcely open in a natural date -r
though they are dilated in fevers, from which the chief of thofe examples
of Donatus are taken •, you would neither anfwer the objection of Pada, nor
obviate the other phoenomena, on account of which thefe ducts have been
fuppos'd to exid : and, certainly, in the fird of Donatus, from Trin-
(mj Supra n. i. (») De Morbis. 1. 4. n. 28. (0) De Med. Hift. Mirab. 1. 4. c. 2-.
2 cavellius,.
Letter XLI. Article 3, 4. 451
aavcllius, the liquor that was drunk ought rather to have conftring'd
orifices of thole ducts, as the patient rcfus'd to drink any thing " thai
44 not almoit cold."
Hut what fli all we lay, you will alk, to a more late observation (p) ? I mean
of that virgin who had ail afcitcs, and in whom " the left kidney, as well
" as the right was univerlally fcirrhous, and indurated •, and had
" coaleic'd in fuch a manner, that even no pelvis could be dilcover'd •," not-
withstanding this patient had difcharg'd urine, though indeed " in a very
" fmall quantity, and limpid like fountain-water," inltead of being " red, and
" thick," as in the beginning : but Hill, however, (lie had difcharg'd
urine,
Was it becaufe a little quantity of the fluid ftagnating in the belly, had
pals'd " through the pores of the bladder, which went from without in-
" wards ?" Or, rather, becaufe fome fmall part of one, or other, of the
kidnies, had not been as yet, entirely indurated, and conftricled, when (lie
laft made water, as it appear'd to be after death •, for which reafon urine had
(till been lecreted through the narrow pafiages, as the unufual limpidity of it
feems to demonftrate ?
Certainly, it did not pafs through duels opening into the ureters, or blad-
der i inafmuch as they would have brought a much greater quantity of fluid,
from the llomach.
3. But be this as it will •, I (hall here give you what Valfalva and I have
leen in the dead bodies of thofe, who, while living, had labour'd under a
fuppreilion of urine, from a diforder of the bladder or urethra •, yet what I (hall
now give you is not the whole. For you have had in the laft letter (q), and,
-in like manner, in the twenty-fourth (r), fome of the appearances which he
had obferv'd ; and fome of thofe that I have obferv'd, in the fourth letter (j),
and tenth (t) : and in others you will have other remarks. "What I fuppos'd,
then, to relate principally to this fubject, among the papers of Valfalva, are
the following.
4. A young hufbandman •, whofe two brothers, and they young men alfo,
had died of acute difeafes, about the vernal equinox, in the preceding years ;
died in this manner, at the fame time of year. Having repell'd a fcabies by
I know not what kind of ointment, his urine was foon after fupprefs'd, not
without a vomiting, and pain, fometimes, in the loins on the left lide. How-
ever, he did difcharge urine after this feveral times •, but in fmall quantity,
like a faturated lixivium in colour, and with pain : it was in vain attempted
to increaie the difcharge by introducing the catheter.
At length the whole body fwell'd : and a large and laborious refpiration
coming on, he died on the day following ; which was about the twenty-firlt
day from the beginning of the fupprefl'ion.
The bladder and the kidnies were found •, except that thefe laft-mention'd
parts were fomewhat larger than their natural fize : and the bladder contain'd
about two pints of urine, fuch as I have faid was difcharg'd. And in the cavity
(/•) Commcrc. Litter, a. 1743. Hebd. 25. n. (r) N. 7.
2. ad 3. (s) N. 19.
r^ n. 4. /,; n. 13.
M m m 2 of
452 Book III. Of Difeafes of the Belly.
of the belly was a ftagnating fluid, that fmelt like urine, though fimilar to
limpid water. This fluid, being preferv'd in a glafs vefiel, feparated into
many broken parts, like what are generally contain'd in urine.
But when put upon the fire, it at firft became turbid, and fimilar to the
whey of cow's milk, and foon after like milk itfelf-, and, finally, concreted to
fuch a degree, as perfectly to refemble the white of an egg : a concretion of
which kind had been never before feen by Valfalva, in any morbid humour
of the body.
In the thorax, the lungs were much diftended with air, and connected to
the pleura at the back •, they were found neverthelefs. The right ventricle of
the heart contain'd a polypous concretion of a moderate fize, the Left con
tain'd one of very fmall dimenfions.
5. What violent diforders have been brought on, by the repulfion of the
acrid particles of a fcabies, into the blood, has been already fhown by me(u)y
in the cafes of two women. But in thofe patients, thefe repell'd particles fell
on different parts : in this young man they mix'd with the urine, and fell
upon the kidnies and bladder : and by pricking and vellicating the internal
membranes of thefe vilcera, occafion'd a pain in both of them •, by which thefe
thin membranes were crifp'd up, and a refiftance, for that reafon, almoft
conftantly made to the efflux of urine : from whence the kidnies became
larger, by this fluid being confin'd internally ; and the bladder ; either be-
caufe it frequently contain'd fcarcely any urine, or becauie it could not con-
trad: itfelf properly, or rather, becaufe it did not admit the catheter, when
this was introduc'd, into the urethra •, difcharg'd nothing : and when the
catheter was withdrawn, it difcharg'd nothing, but feldom, and that with
pain.
The matter of urine, then, being detain'd in great meafure, in the fangui-
ferous veffels, was, at length, the caufe of death : although it overflow'd into
other parts, and particularly into the cavity of the belly •, as was prov'd by
the odour of the fluid which ftagnated there. For this excrementitious-
fiuid readily mixes itfelf with the humours, that are then fecreted from the
blood.
Therefore •, to produce an example which has not, for I know not what
reafon, been added to the Sepulchretum ; Malpighi (x), in his preceptor Na-
tal i ; whofe ureter and kidney he found to be lurprizingly dilated, from the
urine being intercepted by an obstructed calculus, the luppreflion, which in
the end prov'd mortal, lafting for many days-, oblerv'd that his faliva carried
in it the tafte and fmell of urine, and that the halitus, tranfpir'd through his
fkin, had been of the fame urinous kind.
And Albertini related to me, that the noble youth ; the ftructure of whofe
kidnies we fee defcrib'd by Malphigi, in the letter to Sponius •, had not only
fpat up a faliva, in the fame diieale, which had the tafte and fmell of urine,
but even almoft urine itfelf inftead of faliva ; as the colour, added to the fmell
and tafte alfo, teftified; the matter of the urine flowing to the falivary glands
in fuch a quantity, that the cheeks and the parotid glands were tumid.
(*) Epift. 16. n. 34. & Ep. 38. n. 22. (.r) Op. Pofth.
By
Letter XLI. Article 5. 453
By reafon of this difcharge, perhaps, it was that he liv'd Co long; til), the
fuppreflion being overcome, he made a great quantity of water : although it,
neverthelels, happen'd to him, as it has frequently happen'd to others, when
they have at length difcharg'd urine, after a very long retention ; I mean chat
the humours, and the viicera, being injur'd, and deprav'd, he died not long
after.
Thomas Bartholin (y) ; when he mentions other excretions, by means of
which patients who have the urine fupprefs'd, drag on, or prefer vc life for
a long time-, omits that of the ialiva which I have taken notice of, and enu-
merates llools, vomitings, and fweats. 1 Ie produces an example of ftools
in his colleague (z). And instances of vomitings, and fweats, though he has
not exprefly produe'd any, it is eafy to fupply from the obiervations of
others.
Thus our Vallifneri (a) faw vomiting of ferum come on, after the tenth
day of the fuppreflion -, which ferum refembled urine in its colour, tafte and
odour : and the virgin, who was the fubject of this diforder, liv'd till, many
remedies having been made ufe of to no purpole, both internally and exter-
nally, he at length open'd the paflages of the kidnies by giving mercury in-
ternally, and applying it outwardly.
Thus a phyfician of Mantua (b) faw another virgin troubled with the fame
difeafe, and a vomiting, at firft, more than forty days •, and, not long after,
at lead for two and thirty days. Thus another (c) faw a third labour un-
der this fuppreflion, and vomiting, for fifteen months •, fo that (Tie could
fcarcely be fupported by any other means, than that of nourifhing glyfters :
till the calculus being difcharg'd, the iichuria, and the vomiting of urine,
went off".
But where the calculi, which obftruct the kidnies, and the ureters, can-
not be remov'd ; in vain, as Gulielminus (d) has oblerv'd in two cafes, do
vomitings of urine come on : and this is to be underftood both of other infu-
perable caufes of difeafe, and of other dilcharges : in a woman, therefore (e)^
who already perceiv'd the tafte and fmell of urine in her mouth, the vomiting
of blood itfelf, and the difcharge thereof by the noftrils, if it was at all of
life, was lb far of ufe, that fhe drag'd on life quite to the thirtieth day of the
difeafe.
To return, however, to the excretions fpoken of by Bartholin •, he has par-
ticularly pointed out the obfervation ofCarolus Pifo (/J, as worthy of remark,
in relation to fweats-, for they were conftant, copious, of long continuance,
and fo foetid that the fmell of them could hardly be endur'd : a difcharge
by the urinary paflages, therefore, coming on again, the patient was freed
from his difeafe. Not thus fortunately did it happen to the virgin of whom
Petrus Nannius has given the hiftory.
In her the urine had alfo been long fupprefs'd by reafon of calculi, fo thai
he now thought her quite loft ; when a fweat burft forth in an immenfe quan-
fj) Cent. 4. Epift. Med. iS. (c) Aft. n. c. torn. 3, obf. 6.
(z) Ibid. & Epift. 21. (d) Exerc. dc Sang. Nat. n. 63.
(a) Eph. 11. c. cent. 9. obf. 50. {e) Eph. n. c. cent. 6. obf. 56.
(£>) Hiit. de l'Acad. R. des Sc. A. 1715. obf. (f) De Moib. ab Aqua S. 4. c. 6. obf. 127
Anat. 3
uty.
454 I^ook. III. Of Difeafes of the Belly.
tity, that had a urinous odour. As long as this fweat lafted, and it lafted
many days, the virgin was much better. But when this ceas'd, (lie was car-
ried oil' within a few days, by a dropfy of the thorax.
But more happy, for a time, than this was another virgin of Padua for-
merly, of whom Marcellus Donatus (g) gives the hiftory, from a phyfician
of undoubted credit. In her, not from the whole body, but only " from the
" rt-gion of the ftomach, a humour was tranfpir'd to the weight of many
" pounds, rcfembling urine both in colour and fmell-," whereas not only the
natural difcharges of the kidnies were fupprefs'd, but the natural difcharges
of the inteftines alio. And thefe difcharges were fuppos'd to have fupplied
the defect of urine (which for fix months before had been wholly fupprefs'd)
that is to fay, in confequence of the inteftines being then " relax'd."
And even infenfible perfpiration feems to have fupplied this defect, in a
young woman, who •, which is a very extraordinary inftance, though well-
known at Verona.; had not excreted a drop of urine for two and twenty
months, when the celebrated Zeviani (h) mention'd it. for in the bed-
chamber of this woman an odour of urine was perceiv'd, which the bed-
clothes alio feem'd to exhale. In the mean while fhe was affli&ed with many
difeafes though with none of the brain. But that virgin of Padua at length
fell into a marafmus.
Thefe obfervations I have quoted, although they in general relate to thofe
perfons, in whom the urine is retain'd, by the diforder of the kidnies •, which
caufe had alio partly exifted in that man whom I have fpoken of from Val-
ialva: neverthelefs they fufficiently mow from whence they alfo penfh, in
whom it is long retain'd, only from a diforder of the bladder, or urethra ;
and yet there is not that inflammation of the bladder at the fame time, to
which, or the fubfequent gangrene, we may afcribe the death of the patient.
To that kind I ihould fuppofe this fecond obfervation of Valfalva to be-
long.
6. A man, of feventy years of age, having labour' d under a long difficulty
of making water ; fo that he difcharg'd no urine but by the help of the ca-
theter; finding his diforder increafe every day, was oblig'd to come into the
hofpital of St. Mary de Vita at Bologna. There, while the lithotomift was
endeavouring to procure an exit for the urine, by means of the catheter,
without effecr., he died with a laborious refpiration and a ftertor.
The fibres of the urinary bladder had fo increas'd, as to refemble the
ftrong bundles of fibres in the heart ; and that both in figure and magnitude.
An excrefcence of the proftate gland, in the form of a pear, and fcarcely
leaving any pafiage, had been affedted with an inflammation in the lower part ;
from the continual impetus of the catheter.
The right ventricle of the heart fhow'd the beginning of a polypous con-
cretion.
7. It is evident that an inflammation, of that kind, could not be the caufe of
death in this man. However, to what a pitch the blood might be, by de-
grees, deprav'd, in a body thus weaken'd by old age, and by a very frequent
retention of urine, fo as to be confin'd to bed, it is not difficult to conjecture.
ig) C 27. cit. fupra ad n. 2, (b) Del flato, 1. 2. c. ii.
It
Letter XLI. Article 8. 4.55
It is not furprizing therefore, that a retention coming on, which could not
be remov'd by the catheter, inch fymptoms fhould befit) during the time
of the fruitlefs irritations from that inltrument, as at length carried off the
patient in a fliort time.
Even without thefe irritations, he would have died nevertheless : but per-
haps a little later, as lb mar.y others have done-, and among thefe a man,
alio, whofe hiftory I fhall add at prefent, juft as I receiv'd it from the fame
phyfician, whom I have commended to you on a former occafion (/), I mean
Marifati.
S. A man, who lay in this hofpiral for a fuppreffion of urine, had already
had it drawn off twice, by means of the catheter, and always in great quan-
tity. As either the patient, or others, fear'd left the neck of the bladder
fhould be too much irritated by this introduction, and, for that reafon, ab-
itain'd from it, death came on not without convulfive fymptoms.
When the body was open'd, all the vilcera, and even the bladder itfelf,
were found to be, as far as we could judge by the fenfes, perfectly found ;
for the bladder was only diftended, without any beginning of inflammation,
fo as readily to contain fuch a quantity of urine, as three glafs veflels, of the
fize with thofe that we ufe to receive blood from a vein when open'd, or even
to receive urine in this country, would fcarcely have contained.
9. To what a degree I have, more than once, found the bladder diftend-
ed, and yet not inflam'd, not only obfervations already written to you (k) de -
monftrate, but will alio be fhown by one, in particular, which I fhall give
you when I treat on the fubjedt of lamenefs (/). Now that you may conceive
how much the bladder may lbmetimes be extended without any ill confe-
quence, I will fubjoin what happen'd here to a woman of character, whom I
very well know, and who is now in very good health.
She was in labour of her firft child, and more than two and forty years of
age. As the bones of the pelvis did not, for this reafon, at all give way,
and the lower part of that cavity was narrow, the large head of the child
ftuck there-, and the urethra, and the neareft part of the bladder, being com-
prefs'd thereby, the urine was ablolutely confin'd. The fhort kind of cathe-
ter, which is made ufe of for women, was at length introdue'd after great
difficulty, but to no purpofe.
There was a neceflity, then, of introducing one of the longeft which are
us'dformen-, but lefs curv'd than in general: and now it had enter'd to*
the length of a fpan, yet no urine came forth. It was neceffary therefore,
to thruft the catheter up higher, in order to difcharge that fluid ; and by
this means the urine came forth to the quantity of about four pints.
She was a very fmall woman : from whence you will better perceive how-
much (which was alio fhown by the very high and peculiar dwelling of her
abdomen) how much, I fay, the bladder muft have extended itfelf; and evert
the fuperior part of the bladder, fince the inferior part was fo comprefs'd as I
have faid, as to be prevented from extenfion. However, the child, which
was not only dead, but had even a very putrid fmell, being foon after taken
away, no injury or danger from the bladder remain'd.
(/') Epift. 27. 0. 4. .(/) Epift. 56. n . 12.
(&) Epift. 4. n. 19. & Ep. 39. n. 33.
Rvv.
456 Book III. Of Difeafes of the Belly.
But if you inquire after examples of this cavity being greatly diftended,
and attend to the event which the greater part of them have had j to let afide
rupture, which has been found from the diftention, even in the bladder of
an ox(/;/) ; you will certainly find, that, according to the different difpofiti-
on, and nature, either of the parts, or of the blood, or of the urine itfelf,
it has happen'd far otherwife to many, than it ^'d to the woman in queftion.
It is generally known that the bladder, when diftended to a very great de-
gree, has frequently loft the power of contracting itfelf-, and this, as you will
gather from the obfervation of Mauchartus (»), may fometimes happen in a
Ihort time : for this author, after an ifchuria of the bladder, which had be-
gun four days before •, although after the two firft days he had taken care
that the water fhould be drawn off more than once, and found the bladder to
be quite empty in the body after death ; neverthelefs obferv'd that refervoir-
to be " very large, and not contracted as it generally is."
Nor is it lefs commonly known, that the bladder is eafily affected with in-
flammation ; the beginnings of which only exifted evin in this body: fo that
the inflammation itfelf in many others is found to be much more confiderable.
"What is the very natural confequence of this inflammation, you will learn
from the authors who are quoted, as witnefles of a very great diftention, by
Henricus Meibomius (o) -, who, neverthelefs, I know not how, produces one
obfervation of Hildanus as two.
For Hildanus has defcrib'd the fame obfervation, which he has mention'd,
in a flight manner, in the fifth chapter of the book De Lithotomia^ more at
large in the fecond Centuria, obfervation fixty-five ; and tells us there that he
had found in the body of an old man after death an ulcer of the bladder which
penetrated quite to the inteftinum rectum. But that is a much more fre-
quent confequence of inflammation, which you will find to have been three
times obferv'd by another of the authors quoted by Meibomius, I mean Pa-
narolus (j>) ; that is to fay a gangrene degenerating into a mortal fpha-
celus.
I never remember to have feen a more confiderable gangrene, after an in-
flammation which had feiz'd upon the bladder, when it had been, for a long
time, diftended, than in the body of a ruftic which fome unexperiene'd young
men had improperly taken care fhould be carried into the anatomical theatre
at Bologna, in the year 1706, without any previous examination.
10. This man, as was found out afterwards, having been fubject to difor-
ders of the kidnies, bladder, and inteftinum ileum, had now been, for fome
days, incapable of difcharging his urine. Wherefore, his belly being become
tumid and black, he died.
The lower parts of the belly, particularly the vifcera, and among thefe the
bladder, were of a blackifh colour ; as the fcrotum was alfo : and in this was
an intercepted portion of the inteftine I have mention'd; the blacknefs ex-
tending itfelf not only into all the neighbouring parts, but even half way
down the thighs : fo that we were obliged to fend almoft the whole body
away, very loon, left the violent putridnefs of the fmell fhould infect the
(m) Aft. n. c. torn. 8. in obf. 2.
(») Eph. a. c. cent. 9. obf. 41.
(0) Exercit. de Catheretifmo thef. 17.
(/) Jatrolcgifm. Pentec. 1. obi. 27.
whole
Letter XLI. Article ir.
457
whole college. I did juft take notice of fbrhe things in the kidnies, in a cur-
fory manner, which, as I have ddivcr'd them in another place (f) I (hall not
repeat at prefent.
II, Whether the interception of the ileum preceded the fupprtflion of
urine, orthis preceded the interception of the ileum, I could not learn foi a
certainty. This however I know, which I have alio aliened in a former 1 t
ter (r), that to an inflammation of the ileum was join'd a fuppreifion ol
urine.
But there are alfo many other caufes, fi tinted on the outfide of the blad-
der, which obltrudr. the urine therein. I have juft: now (s) fpoken of the
foetus prelling upon the cervix of this refervoir, in a difficult birth : and even
in utero-geftation, particularly in the latter part of the time, there are wo-
men, lbmeof whom I have very well known, who cannot make water, but in
a lupine polturc.
Add to thefe things : to pafs over thofe which happen, very rarely •, for we
know that a glandular body has been found growing to the female urethra,
externally, " of more than the fize of a man's fift (/)•," we know that very
acrid medicines applied to the pudendum, in order to conftringe it more
clofely, the firlt by preffing upon the urethra, the latter by exciting a very
violent inflammation, have brought on a mortal luppreflion of urine •, which
we are not ignorant has even been caus'd by the blood diftilling, by degrees,
from aveflel of the wounded omentum, coagulating in the pelvis, and greatly
compreffing the neck of the bladder (u) : add to thefe, I fay, a great quan-
tity of very hard excrements, or very tumid haemorrhoids, which may preis
the neck of the bladder againft the bones of the pubes, in fuch a manner, as
to prevent any of the urine being difcharg'd.
To this cafe of the piles, relates what Giovanni Amatorio, a very old and
fuccefsful furgeon, in the place of my nativity, aflerted to me, when I was
a young man ; I mean, that when the fibres about the lower part of the blad-
der are turgid with ftagnating blood, or humour, it is of very great advan-
tage to apply leaches to the hemorrhoidal veins.
Thus in the grandfather, who was even then alive, of Peter Scanelli ; a gen-
tleman of rank, and one with whom, by reafon of his fondnefs for polite learn-
ing, I was very familiar •, when Amatorio himlelf had been oblig'd to draw
off the urine, by the introduction of a catheter, ninety times, he affirm'd that
this very obftinate fuppreflion had been at length remov'd by that remedy,
after many other remedies had been adminiftcr'd in vain.
And as to hard excrements, the obfervation of Wepfer (x) is' very well
known : to which •, as it is alfo transfer'd into this lection of the Sepulchre-
turn (y), but not without fuch typographical errors as render it quite unin-
telligible ; you may add another that you read in the Additamenta to the next
fection, that is the twenty-fifth (2).
(q) Epift. 38. n. 41.
(r) Epiih 34. n. 8.
W N. 9.
(/) Aft. n. c. torn. 1. obf. 20 j.
(«) Vid. Hoffm. Med. Rat. torn. 4. p. 2. f.
2. c. 7. in ipfo fine.
(x) Auftar. Hid. Apoplex. 13. Schol. 8. ■
(j) In append. I. ad obf, 19.
(z) Obf. 5.
Vol. II.
N n n
The
458 Book III. Of Difeafes of the Belly.
The fame happy fuccefs which the firft relates from the injection of a gly-
fter, not only many have experienc'd in other places, but was in particular ex-
pcrienc'd here by a Jew, to whom no other remedies had been of fervice. It
is then, however, fufRcient to inject fuch things as are emollient ; efpecially
if there be the leaft danger of an inflammation of the bladder, or a fufpicion
of any convulfive ftricture of the fphincter thereof.
Neither of thefe circumftances, a fenior phyfician, who related to me two
or three of his fuccefsful cures, feem'd, to me, to attend to fufHciently ; for
by giving fuch things as purged the intettines pretty briikly, he laid he had
caus'd the fupprefs'd urine to be difcharg'd, at the fame time with the
ftools.
By this means, faid he, if I had not caus'd any real difcharge of urine, yet
at leaft the more fluid I had drawn out from the inteftinal paflage, fo much
lefs would, of courie, have flow'd down by the kidnies, in order to diftend
the bladder more and more : and the fluid, with which the bladder was di-
itended, was excited at the fame time -, as by ftimulating the inteftinum rec-
tum, I could not avoid ftimulating the fibres of the neighbouring bladder to
contraction in like manner •, and in great meafure reftoring to them their loft
power.
But he did not fufHciently obferve, that no part of the bladder was more
clofely join'd with the inteftinum rectum, than the lower part •, or if you
pleafe the beginning of the urethra : nor did it occur to him what mult
therefore be the confequence, if this part fhould be, at that time, affected
with any beginning of inflammation, or convulfion.
It is true, I do not difallow that the bladder, at one time, lofes its power
of contraction from a paralyfis ; and, at other times, from the diftention
itfelf. But I fay this, that the caufes of a fuppreflion of urine in the bladder
ought to be very carefully diftinguifh'd : nor are we to imagine that the power
of contraction, inherent in the mufcles of the bladder, is always fo eafily and
fo foon taken away by diftention ; as we have gather'd above (a) from the
example of Mauchartus.
This is demonftrated ; to take no notice of other things •, by the dog
which Boerhaave diflected (b) : for in this animal •, although the bladder was
extremely full of urine, that had been retained already, for the fpace of three
days-, when the bladder was pundlur'd with a flight wound, ii the urine ne-
" verthelefs fprang forth to a great height : and the bladder contracted itfelf
" to fuch a degree, that fcarcely any cavity remain'd.
12. There are alfo many other caufes, which, as they have it in their power
to retain the urine in the bladder, fo they alfo forbid theufe ofthofe ftimuli,
whereof I have fpoken •, as, for inftance, that which I l<now to be in the place
of a domeftic remedy with fome : I mean the application of a tile, or brick,
which has been previously immers'd in cokl water, to the foles of the feet of
a perfon who has a retention of urine: and this remedy a phyfician, that was
a friend of mine, imitated with a happy boldnefs, when he was a young man,
by applying ice itfelf to the feet for a little time,
(«) N. 9, (£) Prasled. ad Inftit. \. 366.
4. For
Letter XLI. Article 12. 459
For, although thefe things may poffibly excite the ftupified power 1
bladder, by Simulating the extremities of thi \ you, without
doubt, are aware how noxious thefe irritations may be, where the retention
of the urine has begun from the acrimony thereof: or where; according
to the conjectures of the very diligent Pujati (c), and the obiervations ot
the very experiene'd Benevoli (d) ; the bladder is depriv'd of that mucus,
wherewith it is ihiear'd over to defend it againlt the too great flimula of the
urine.
I fay nothing of the bladder itlelf falling clown into the fcrotum, although
I have learn'd, from the time that my friend Georgio Georgi ; a phyiician of
great eminence, at prefent, among the inhabitants of Pelaro ; wrote to me,
that this is not fo rare as was fuppos'd by Mery(^) •, who, when he defcribes it
as having been (etn twice by him, confcls'd that he did not know of any
author who had made mention of it.
For I have certainly feen it taken notice of, from Platerus, in this fedtion
of the Sepulchretum (f) ± and in the laft foregoing fection, that is the twenty-
third (g), from Bartholin : and I have alio read of it in Ruyfch (h), who faw
it more than once (/') •, as is juftly refer'd to by Chriftian Andreas Kochius (k),
where he alio mentions another obfervation of a cafe of this kind, of Boer-
haave's : to which, and the others, to omit here the analogous prolapfus of
the bladder in women (I) •, of which, and the figns thereof, you may, in the
mean while, confult Mery himfelf (w) and the celebrated Baffius («) •, you
will alfo add that which the very learned Valcarenghus (0) made upon a
nobleman.
But if this cafe be rare •, in which, when it happens, it is in our power
(and this is the proper and pathognomonic fign of the difeafe) to difcharge the
urine from the bladder, which the patient railes up with his hand, together
with the fcrotum, or compreffes ; there are others that are frequent, as thofe
from a pretty large calculus : and if we attend to Hoffmann (p) ; who ex-
plains one of his obfervations (j), and directions, in this manner in particu-
lar, from a fpafm of the bladder itfelf •, others that are lefs frequent •, as from
the external coats of the bladder, as was feen by the fame author (r)t being
eroded, and very much lacerated, by a foetid pus, which had fallen down
into the pelvis from the left kidney, that was entirely confum'd and deflroy'd
by an ulcer, or even as from tubercles ; there are, I fay, other fupprefiions
of urine in the bladder, wherein, not only no affiitance is given by the ap-
plication of ftimuli, but much detriment muft be the confequence.
And there are tubercles fometimes in the bladder, or at its neck ; although,
as is clearly demonftrated by Benevoli (s), whom I have quoted, even excel-
lent phyficians have been decciv'd in fuppofing them. There are, I fay : for
(c) Dec. obf. 3. n. 5. (/) Vkl. tamen & Epift. 43. n. 14.
(J) Difiert. 2. \m) Mem. cit.
(e) Mem. de l'Acad. R. des Sea. 1713. \n) Dec. 3. Obf. Anat. Chir. 2.
(f) Obf. 17. %. 4. in Schol. (0) Difiert. de Saxis, Acub. Sc caet.
(g) Obf. 4. $. 4. (p) C. 7. fupra ad n. 11. cit. Epicr. obf. [.
(I) Cent. obf. 98. (7) Ibid.
\i) Adverf. Anat. dec. 2. n 9. (r) Ibid. obf. G.
' Afieft. in libr. & caet, rar. Defer, in Ra- (-0 Di/E z. cit.
tid'u"..
N n n : al-
A-6o Book III. Of Difeafea of the Belly.
although RuySch (7) repreSents only one example-, yet that many are to be
met with, he Sufficiently Shows in the fubjoin'd observation (u).
What tubercles were feen by Drc'lincurt (#), what an excreScence was found
by Sylvius (y)t what a caruncle by Tulpius (z), by Smetius («), by Hilda-
nus (b), you have, not to lead you too far, in the Sepuichretum itfelf, where
you will alfo certainly find other things relating to the fame Subject. And
perhaps you will ftill remember that which I formerly defcrib'd in the fir It
Epijlola AnatBmica (c), as being found by me, as well in the urinary, as in the
biliary bladder.
And although it is Superfluous to produce examples of tubercles, which
arife in the meatus urinarius, fince mention is made of them in the very
aphp.rifms of Hippocrates (d), and of the fuppuration whereby they are re-
rnov'd ; yet I fuppofe it will not be unpleafing to you, if to the hiftory of
that nun, who was preferv'd for the fpace of fixty-fix days, by the help of nou-
rishing glyfters, under the attendance and care of Rammazzini («?) ; I add this
alio, which I receiv'd from him : I mean that the fame virgin ; when She was,
afterwards, feiz'd with a fuppreffion of urine, and refus'd the aSfiftance of the
catheter; after the cafe had gone on to an extremity, by the delay of fome
days ; had begun to difcharge her urine, together with a Small quantity of
pus, without any pain, except of the urethra : and by this had Shewn the
caufe of the diforder to be a tubercle form'd in the urethra. And as the
v/ell-tim'd fuppuration, of this tubercle, took away the difeafe, fo the irri-
tating powers, of the remedies fpoken of above, would have increas'd it.
But tubercles of this kind may, however, eafily be chang'd into pus, and
leave the paSTage free and open. But who can have any reafonable hope,
that fcirrhous tumours, or tumours verging to the hardnefs of a fcirrhus ;
iuch as are often found in the proState gland, or frequently grow out there-
from ; may be eafily remov'd by nature herfelf, not to fay by art ? And
Juch I believe that excrefcence of this gland to have been which is defcrib'd
above (f), from the obfervation of ValSalva : and of the fame kind, without
doubt, was the tumour of the whole proftate, in the following obfervation
of mine.
13. A fellow-citizen of mine, of noble birth; who was more than Sixty
years of age, of a Square and robuft body, had a red face, a habit inclining to
fatnefs, and was troubled with a hernia-, had labour'd, when a young man,
under a virulent gonorrhoea, and had always drunk very freely, and often
even of pure wine.
Though he alio made a great quantity of water, and very frequently ; yet
the year before he had been attack'd with a kind of Slight retention of urine.
And in the year 17 10, on the fourth of March, it was almoft fuddenly.
fupprefs'd.
(£) Ibid, in Schol. ad §. 2.
(c) N. 43.
{d) 82. feci. 4; & 59. fe&. 7.
(,*) Conftitut. Epidem Urb. a. 1691. n. zz,
(f) N- 6.
(')■
Cent
obf.
fig-
61.
r«)
78.
(x)
Seft.
hac
24-
obf.
«3-
§
00
Ibid.
obf.
10.
§.6.
(*)
Ibid.
cbf.
8.
(a)
Sett
25.
obf.
!•§•
4-
A phy-
Letter XLI. Article 13. 461
A phyfician, who was his kinfman, took great pains to administer r<
;lyfters, baths, and blood-letting from the hemorrhoidal veins 5 and even
by uk.1i remedies as increas'd the inteftinal difcharges, which were at the I
time diminifh'd : but to no purpofe. Me therefore, at length, order'd the
catheter to be introdue'd : which was done without great difficulty, both
then, and afterwards. And at each time of introducing ir, almoil feven pints
of urine were drawn off", on the firft days from the time it began fird to be
introdue'd ; notwithstanding he had bur little given him to drink.
On the intermediate days, for he liv'd, in all, about fifteen, the quantity
was ibmewhat leis : and on the lad days the quantity again amounted to feven
pints. And on the firft days, indeed, he perceiv'd fome inclination to make
water; as he alio did on the latter days: but none at all in the interme-
diate days. A little blood was fometimes feen in the urine; and fometimes,
fome fmall pieces of membranes as it were-, on the lad days a pain of one
fhoulder came on : a fever on the lad but one : and on the lad, in the morn-
ing, when the catheter was withdrawn, after taking away the urine, it was
obferv'd to be ting'd •, which was a circumdance that had never happen'd
before ; jud as if it had been dipp'd in a vitriolic fluid.
On that day, when the evening began to draw on, behold a rigor, and a
tremor came on ; though the fkin continu'd warm ; and from hence thepulfe
was obfeur'd : and as foon as it began to be difeover'd again, not without in-
termiflions •, another tremor came on : and at the fifth hour of the night the
patient died.
Being afk'd to attend the difiection of the body, I attended, together with,
other phyficians, about the beginning of the night of the following day :
at which time 1 receiv'd the account I have given you, from the phyfician
who had attended the patient while living; and from the furgeon and others ;
all of whom confirm'd the relation.
We found the peritonaeum to be livid ; particularly in the hypogadrium ;
and the inttdines, in general, to be of a livid hue: in the extreme part of
the fundus of the didended bladder, the blood-vefiels were externally tur-
gid with blood ; and the internal coat was redifii in feveral places: but all
the coats were much thicker than they naturally are ; for which reafon the
bladder, even when emptied of its urine, retained an unufual magnitude.
Before the whole of the urine was difcharg'd from that cavity, we obferv'd
a coaguium, of no very fmall fize, to be fwinrtming freely about, and to re-
femble nothing mere than a femi-lacerated hydatid ; but when I examin'd
it more attentively, it feem'd to be a fiender polypous concretion, which refem -
bled fmall membranes involv'd one in another, and collaps'd : and thole who
faw it affirm 'd that it was of the fame kind with thofe fmall fragments, which
had fometimes appear'd in the urine, after being drawn away.
"When, therefore, we came to inquire into the caufe cf this fupprefilon,
it appear'd to be at the lower part of the bladder. That is to fay, the pro-
date gland was univerfally fwollen out in a preternatural manner, and had at-
tain'd to fuch a date of hardnefs, as to feem to thofe who cut into it, to con.-
fid of the fubdance of cartilage and ligament mix'd together as it were.
This;
a'62 Book III. Of Difeafes of the Belly.
This tumefied gland was of a white colour-, except that, in fome places,
but particularly on both furfaces, it was blackifh, from blood ftagnating
in the veflels; and that mod on the right fide, where the fcrotum was, in
part, diftended with a large enterocele.
14. In this caufe of fupprefiion, which has been juft defcrib'd, all of us,
who were prefent, eafily agreed : not only becaufe we were not ignorant that
the fame had been met with, at other times alio, by eminent men, and ac-
knowledge •, as will be faid afterwards (g) -, but alfo becaufe it was eafy to
conceive, that when the patient began to be affected with a tumour, and hard-
nefs, of the proftate, he began alio to be attack'd with the beginning, as it
were, of a retention of urine : and that when the tumour was, at length, in-
creas'd to fuch a great degree, an unufual flownefs of circulation, through
this gland, and round about this gland, coming fuddenly on, the canal which
pafs'd through it, could not be fufficiently open'd for the difcharge of the
urine ; unlefs by introducing the catheter which was a folid body.
Nor would I have you fay, that the blood, which was difcharg'd by the
application of leaches to the neighbouring veins ; a remedy that I have fpo-
ken much in praife of above [h) ; ought to have recover'd the former cele-
rity of motion ; and by this means have diminifh'd the tumour. For in a
full habit of this kind, blood not having been previously taken away from
the arm, a greater quantity of this fluid eafily flow'd to that part, from
whence it ought to have been repell'd ; by reafon of lefs refiftance being made
to its influx.
I omit inquiring whether, on account of the baths alfo, which had been
then made ufe of, this might happen ; or even, whether a ftimulus was added
by thofe medicines, in particular, that were given to increafe the intefti-
nal difcharges. I alfo omit this inquiry •, whether the urine began to be drawn
off later than it ought to have been: which was an objection I heard com-
monly made ; at that time more than any other •, though I faid nothing about
it myfelf, according to my ufual cuitom •, as every reflexion of this kind is fu-
perfluous, and ufelefs to a patient who was already dead.
The caufe of this objection, however, does not feem to be unworthy of our
notice. It had happen'd in thofe days, that four other citizens, befides him
of whom I have fpoken, were fuddenly feiz'd with the fame diforder; and
that what the celebrated Baffius (i) obferv'd afterwards, at Hall in the dutchy
of Magdebourg, in the ipring of the year 1730, u to be quite unheard of-,"
I mean that a true gonorrhoea fpread about epidemically ; as he teftifies, by
producing four obfervations; we obferv'd in the fpring of the year 1710, at
Forli (a. city not abounding with inhabitants, in proportion to the advantages
it enjoys, nor as it formerly did) in regard to an ifchuria veficalis as it is call'd ;
five obfervations of which I could produce that were made within a few days,
by-way of an uncommon inftance, which perhaps might be explain'd nearly
in the fame manner that he has explain'd his, or, at lean:, in great mea-
fure.
The city therefore, feeing that out of our five citizens, one of whom I at-
tended myfelf, four had recover'd; and he only, whole diffeclion 'you have
.(g) N. 17. {b) N. n. (/) Dec. 4. obf. anat. chir. 5.
read,
Letter XLJ. Article 15. 463
read, had died | commended the forefight, and prudence, of the others, in
the early introduction of the catheter, and blam'd the delay of this phyfician
in queftion: but whether juilly or unjuflly, 1 have to you to determine.
Yet as there are different caufes of dite.iics in different perlbns, anil diffe-
rcnt flates of body, of the parts, and of the urine-, fo there may be different
reafons, in different patients, why a phyfician fhould take any ttep inltantly,
or delay to take it for fome .time. I confefs I was not lorry for having made
uie of the catheter fo early, in my patient, after more eaiy remedies being
tried to no purpofe ; although to the furgeon it feem'd fo premature, that,
by reafon ot the very fmall tenfion of thehypogafhium, he alferted that there
was no urine in the bladder.
But he was immediately refuted : though not fo much by the figns of a
renal ifchuria being abfent, and by the other figns of a very troublefome
vefical ifchuria, being prelent, as by the thing itfelf.
For no fooner was the catheter introdue'd, but it brought off three pints
of urine, to the great eafe of the patient ; who was furpriz'd how it could
happen, that he, who drank fo little, fhouW have fuch a quantity of urine
in his bladder : being ignorant, that, with this fuppreffion, an affection of the
diabetes kind, as it were, is frequently join'd ; which confideration has fome-
times led me to doubt, whether this diibrder of the diabetes kind, were not
the caufe of the fuppreffion : I mean by fo nattily, and furprizingly, diftending
the bladder, while the patient fleeps, that when he awakes, the mufcular coat
thereof is no more able to contract itfelf.
But whether the patient; into whole bladder our Fabricius ab Aquapen-
dente (k) fays that fo great a quantity of urine had flow'd (while nature
was bringing about a crifis) that, he not being able to difcharge it, there
was a necefiity of drawing it. off by the catheter ; whether this patient, I fay,
ilept like mine •, or whether, as he lay ill of a continual and dangerous fever,,
his fenfations were become obtufe •, as we do not certainly know, fo we are at
liberty to fufpect either the one or the other : for it does not, otherwife, ap-
pear, why he did not difcharge his urine from the time it began to flow,
pretty plentifully, into the bladder; and why, by continuing this difcharge,
he did not take care to prevent the whole quantity, that was fecreted, from
being retain'd in the bladder.
15. That you may not inquire after examples of the conjunction of both
thefe diforders, which I fpoke of juft now among other authors •, that is to
fay, of the diabetes and the ifchuria, of which kind in particular was that of
Hildanus in the Sepulchretum, which having fome reference to the cafe of
the old man mention'd above (/), is transfer'd into this fection under article
the eighth of the tenth obfervation, but of that which (lands firft in order
(for another obfervation immediately fucceeds, which is, through careleffnefs,
mark'd out by the fame number) and that I may not add other more recent
examples which have come to my knowledge -, it is fufficient to read over
again the hiftory in queftion (,n).
You will fee, notwithftanding the patient then drank but little, how great
a quantity of urine flow'd down into the bladder. I am forry we did not cx-
(i) DeChirur. Operat. ubi deurin, Supreff. (!) N 9. («)' .N. 13.
amine
464 Book III. Of the Difeafes of the Belly.
amine his kidnies and liver. Yet I am not forry, for this reafon ; becaufe I
fliould have hop'd that 1 could learn out the caufe of thofe circumftances
which happen in the diabetes.
For to let afide the more wonderful things that are related of the true dia-
betes (n)^ fome of which, I think, ought not to be admitted without a cau-
tious examination ; it is certainly notlefs furprizing to confider what has, be-
yond a doubt, happen'd in two virgins in the fpurious diabetes, as it is
call'd ; and that even in our age, and neighbourhood, at Venice (0), and
Bologna (p) ■> fo that one of them, within ninety-four days, difcharg'd three
thoufand fix hundred and feventy-four pints of urine : and the other, within
ninety-feven days, difcharg'd four thoufand one hundred and feventy one
pints of the fame fluid-, whereas both of them not only drank little, or no-
thing, but even, almoft like thofe who labour under a hydrophobia, were
extremely thirfty, and abhor'd the fight of any kind of liquor whatever.
You certainly perceive, that, whatever morbid appearancej may be found
in the kidnies, or liver ; for Me^ad (q) aflerts that " fomething fteatomatous"
had been " always " found, by him, in this laft-mention'd vifcus, by dif-
fering the bodies of thofe who had died of a diabetes •, you certainly, I fay,
perceive, that it cannot for that reafon appear, from whence, I do not fay fo
great a quantity of fluid, but even a quantity lefs by one half, is to be ac-
counted for.
For which reafon, they who have undertaken to explain the cafes of thefe
virgins, have been oblig'd to do the fame thing that Mead has, at length,
exprefly done (r) ; and that phyficians had already begun to do (s) in the
fifteenth century; I mean to have recourfe to the air, and, with greater pro-
priety than thole ancient authors, to deduce this immenfe quantity of urine,
not from the air itfelf, but from the aqueous particles fwimming therein.
It therefore chagrines me, that I did not examine into the ftate of thofe
vifcera which I have mention'd : not becaufe I might have had an opportunity
of obferving the caufe of the furprizing cafes of this kind, but becaufe I
might have, in part, obferv'd fome traces of the caufe of a diabetes notfo im-
moderate ; or, perhaps, rather fome traces of the effects. And I am fo much
the more difpleas'd with myfelf, as there are very few diflections of perfons
who died after that difeafe.
This circumftance appears from the fhortnefs of that fection of the Sepul-
chretum, which profeffedly treats of the diabetes ; I mean the tvventy-fixth.
Of the obfervations, however, contain'd therein; which are, in number, no
more than five ; there are three which either reprefent both the kidnies as
being very flaccid; or one of them, at leaft, as collaps'd into itfelf, or almoft
confum'd.
With thefe agree the two obfervations of Ruyfch (t), which I wonder were
not added ; for Hoffmann (u) had not publifh'd his at that time. Which
(n) Vid. fupra, n. 2. (r) Monit. Med. c. 9. feft. 2.
(0) Cafo propolto da Bartol. Barati & Lodo- (/) Vid. Marc, donat. c. 27. fupra ad u. 2.
vico Tefti con la Rifpofta di quefto. cit.
(p) Comment. deBonon. Sc.Inftit. t. i.fub. [t) Obf. addit. ad Dilucid. Valvular 13. &
tit. Medic. cent. obf. 13.
(qj Expof. Median. Venen. Tent. 1. (u) Confult. Med. cent. 2. caf. 85
like wife ;
Letter XLI. Article 16. 465
Wcewhe-, although it alio fuppoics tlie diabetes to proceed from a previous re-
tention or" urine in the kidriies, and ureters, from whence a great quantity
thereof returns back into the blood, and mull of courfe be again fecreted,
in a great quantity, when the caufe of the retention is remov'd ; neverthe-
lefs brings us back to this fuppofition, that the pores of the kidney were
relax'd, by this very retention, and return of the urine ; as in a certain
Count, who had labour'd under a diabetes, not only the kidney on the right
fide was enlarged to more than double the fize of that on the left, but the
ureter appear'd to be extremely dilated, almofr. to the fize of a common fau-
iage.
And I myfelf alfo •, though I would by no means follow this explication in
all caies •, as in all a retention of urine does not precede, and the quantity, in
which many dilcharge it, far exceeds whatever might be retain'd and re-
turn'd into the blood-, in the cafe of the man, nevertheless, whole hiflory I
have given, and other cafes fimilar thereto, fhall follow it without any dif-
ficulty: as they not only fecrete a much lefs quantity of urine, and fecrete ic
after retention-, but, in this man in particular: becaufe-, as he was always
us'd to drink a great quantity, and make a great quantity of urine, before
his ifchufia came on ; the kidnies feem to have been lax to a confiderable
degree, even before the attack of the diforder.
But what miichief had been added by the fluid-, which, when he at lad
drank but little, the kidnies tranfmitted in lb large a quantity -, I could per-
haps better conjecture, if I had examin'd all the different urines.
For as to their bring-ing on fome ftimulus to dilcharge the bladder of its
contents, on the firft and the lad days of the difeafe, and none in the inter-
mediate days -, this might much more eafily happen from their quantity, than
from their nature -, fince the fluid was fecreted in much lefs quantity, in the
intermediate days, and in a greater quantity on the firft, and the laft : unlefs
you fhould rather choofe to fuppofe, that the fenfation of the bladder had
been blunted, by the frequent diftention -, fo that in the intermediate days it
was no more affected, till, by reafon of the patient's drinking but a fmall
quantity, and by realbn of a large quantity of fluid being fecreted from the
blood, the urine, at length, became lb much more acrid, as even to excite
in fome meafure the obtufe fenfations of the bladder : at which time it alfo
began to excite fome inflammation, here and there, in that vifcus.
16. But if I had feen any erofion, as well as inflammation, on the internal
furface of the bladder, I fhould perhaps have examin'd lefs into the nature of
that coagulum, which had the form of a membrane : and which, being found
in the urine, contain'd in the bladder after death, I fuppos/d to be a poly-
pous concretion -, as I might then have fuppos'd it to be made up of lamellai,
that had fallen off from the internal membrane : for the controverfy which, as I
have heard, did at length, arife fome years ago, was not agitated at that time ;
I mean whether this circumftance could poflibly take place without a haemorr-
hage that could not be appeas'd.
But certainly, a haemorrhage of this kind had not happen'd in the matron
mention'd by Willis (x), who having, long before death, difcharg'd from her
(x) Dirt", de Urin. c. 5.
Vol. II. O o o urethra,
466 Book III. Of Difcafes of the Belly.
urethra, " a thick and broad membrane, fill'd with Tandy matter •" it ap-
pear'd from the diffeclion of the body, that this membrane " was a part of the
*' internal coat of the bladder :" nor did it afterwards happen in two women,
C3ch of whom difcharg'd, from the urinary meatus, a large membrane that
was examin'd by Ruyfch (y) and Boerhaave (z) ; and one of them " fprink-
" ied over, as it were, with fmall calculi."
And it is not to be fuppos'd, that fuch men had taken pfeudo-membran<ey
or falfe membranes, for true ones ; efpecially as Ruyfch had taught (a)t
many years before, the manner in which not only nature, but even art, might
make falfe membranes : and had himfelf made them.
Be this as it will, however •, that certainly was not a falfe membrane, which
Rohault (b) had before feen difcharg'd from the fame paflage, in a man ; as
he found three portions of it only, to be of fuch a large fize, that he did not
doubt but they had made up two third parts of the internal membrane of the
bladder : for it was furnifh'd with regular blood-veffels : and fo far was there
from being any haemorrhage join'd with it, which could not be reftrain'd, that
the urine never appear'd to be fo much as tinctur'd with blood.
It is true, I do not contend that whatever comes out of the bladder in
the form of a membrane, is really a membrane ; as I did not judge it to be fo
in my fellow-citizen. But this I contend for-, that the marks of membranes
are neverthelefs fometimes fo manifeft, that we cannot argue againft the opi-
nion of thofe very experiene'd men who examin'd them, and took them fou
real membranes : nor are we immediately, and upon every occafion, to go fo
far as to deny the facts, becaufe we cannot conceive how fome things can hap-
pen without the moil violent, and even the mod fatal fymptoms. I would
therefore have you fuppofe what I have faid on a former occafion in a fimilar
controverfy, upon any internal membrane abfeeding (c), in great meafure to
take place here alfo.
1 7. I now come to the caufe of the fuppreflion j which was found to confift in-
the proftate gland being very tumid, and hard. I had learn'd that this caufe
was not uncommon, from the obfervations of thofe who are quoted in the
Sepukhretum ; that is to fay of Riolanus (d) Muraltus (e], Dokevs (/), and
even, as I underftand it, of Reifelius alfo (g) : I have not faid from thofe of
others likewife and among thefe, of him who ought to have been nam'd in
preference to the reft, that is of Parey (b), becaufe we do not here confider the
magnitude only, but the fcirrhous hardnefs alfo.
And I have fince been confirm'd in the opinion, both by obfervations of
this kind, that I have heard, and read, and fuch as have been made fince the
others. I have heard of it in two men of note here at Padua, who were very,
well known to me. And I have read of it, not only in other authors, but.
particularly in the celebrated Heifter (i) : and if you attend to the increas'd
(y) Adverf. Anat. Dec. 2. n 9*
(z) Vid Kochii cit. fupra ad n. 12. defcript,
in hiftoria.
{a) Thef. Anat. 7. n. 39.
\b) Hift. de l'Acad.R. des Sc. A. 1714. obf.
Anat. 1.
(c) Epift. 31. n. 20.
(d) be<5t. hac 24. obf. 17. §. 5,
{/) Sett. 25. in additam. obf. 16.
(f) Ibid. obf. 17.
(g) Ibid. obf. 18.
\h) Seft. ead. obf. 1. §. 6.
(/) Inftit. Chirurg. p. 2. f. 5. c. 44. n.
Difl*. de Anat. Maj. in chir. neceff. c. 1.
§. 3. an. 4.
1. U
f.4-
bulk
Letter XLI. Article 18. 467
bulk of the gland only, I read of it, likewife, in the works of two of my
mod rcfpedtable friends, Vallilhcri (k), and Benevoli (/)j to whom you may
join Riedlinus (w).
But the whole proftate gland is not always tumid. For frequently, only
the fuperior circumference of it either grows out on every fide, or on a par-
ticular part ; and fwells to fuch a degree, as to prevent the exclullon of the
urine. I think I can point, out examples from the Sepulchretum, of its being
fo tumid as to have this effect : and 1 have many obfervations of its beginning
to grow out : and thel'e, that you may know what are the fmall beginnings of
great difordcrs, I will take the trouble to fubjoin here, in order, after the
former.
Rhodius (n) defcribes an old man, in this fection of the Sepulchretum, in
whom the difcharge of his urine had been render'd very difficult by degrees ;
and finally, mucus being added, was entirely obstructed ; by M a callous
" appendage growing internally to the orifice of the bladder alone : and ftill
" more by the internal membranous circumference of the orifice growing
" out into the fize of a joint." He certainly might have defcrib'd the cale
more clearly ; as another likewife, might have done, by whom you will read
the fame orifice of Cafaubon, who was fo much troubled with diforders of the
bladder, defcrib'd in the next fection of the Sepulchretum (o) ; which defcrip-
tion is moreover render'd obfeure by typographical errors.
But if I rightly conceive of what both of them have feen •, the circum-
ference of that orifice, which is made by the upper part of the proftate, was
rais'd up by too great a protuberance of the gland. And I have feen that
upper circumference, of the fame gland, beginning to grow out on all fides ;
in an old man whofe hiftory I fhall fend you when I treat of fevers (p). And
I believe that which is given in this fection (q), from Gaffendus, of " a ca-
" runcle, or callous fubftance, at the fphindter of the bladder, that, being
" lunated in its lower part, and almoft as thick as the third of an inch, ob-
" ftructed the orifice of the meatus," to relate to a part of this circumference.
And although you have already had an example, from me, of this incipient
caruncle, in the thirty-feventh letter (r) •, and are to have another alio, in one
of the following letters (s) ; yet I have a mind to add a third here, in confe-
quence of its being fhort, and relating, in general, only to this circumftance.
1 8. A hufbandman, of feventy-five years of age, had died in this hofpital
of an afcites, in the beginning of the year 1741 ; which was the time when
I was demonitrating, anatomically, to theftudents, the organs deftin'd to the
fecretion of the urine and femen.
Thefe organs, therefore, were taken out from the body, and were the only
parts I examin'd. And therein I not only met with fome other appearances
that are not very frequent, though not morbid, which will be taken notice of
eifewhere •, but I obferv'd the following things in particular, which had a re-
lation to difeaie.
As the fcrotum was fweli'd, as it frequently is in an afcites, there was a
great quantity of water in the cells of the dartos, and but little within either
(k) Opere t. 3. f. 3. off. 21. 22. (0) Obf. 3.
(/) Diifcrt. 2. (/.)' Epilt. zj9- n. i >.
(«) Eph. n. c.Dec. 3. A. 9. Si 10 obi". 1.48, (q) Obi'. 12. *. 10.
;<•) Obf. 12. §. 3. (/) N. 30. (.<) Epiih 43. n. 24.
O 0 0 2 tunica,
468 Book III. Of Difeafes of the Belly.
tunica vaginalis : notwithftanding from the albuginea, where it invefts the
tefticle, fuch fmall bodies were protuberant, as are generally look'd upon, by
me, to be the remains of ruptur'd hydatids.
And when the anterior paries of the bladder was cut afunder longitudinally ;
in that part of the oppofite paries, which is neareft to the orifice, and in the
very middle of this part, a roundifh protuberance appear'd : being of the
bignefs of a fmall grape, cover'd over with the internal coat of the bladder.
"What this protuberance was I readily fuppos'd •, and by forcing the knife into
it, I cut through this and the contiguous proftate gland, at the fame time,
lengthways, and fhow'd that it was of the fame nature with that gland : that
it was very evidently continued from it; and that there was no doubt, but,
if it had grown out to a greater degree, it mud have been a very confidera-
ble impediment to the discharge of the urine.
19. If you attentively examine thofe examples which 1 have pointed out
from the Sepulchretum (/), and that which I have produe'd above («), from
Valfalva, and mine ; you will obferve that they were all from old men : and,
in like manner, if you examine all my obfervations in which there was the
beginning of a caruncle, you will find that this was found to grow out in the
very middle of the internal, and upper, circumference of the gland, pofte-
riorly ; but whether all thefe things happen'd by chance, or otherwife, fu-
ture obfervations will fhow.
In the mean while, you may add, to thefe other examples, that old phy-
fician, whom one of the obfervations, refer'd to in Vallifneri (x)t mows to
have had the whole proftate gland tumid indeed, but increas'd with a parti-
cular lobe, as it were, from its glandular fubftance ; which rofe up within the
bladder, in the fhape, and fize, of a walnut : not on the anterior part, but
on that which lies adjacent to the inteftinum rectum.
Yet that roundifh protuberance of the fame gland, which is taken notice
of in the Adverfaria (y) ; except that it rais'd itfelf up from the external cir-
cumference, and feem'd as yet to be in a natural ftate •, that protuberance, I
fay, occupied, in like manner, the middle and upper part pofteriorly.
However, thofe internal excrefcences of this gland that are preternatural,
are not always fimple, but fometimes even in a double ftate •, of which kind
were thofe found by Thomas Bartholin, at Padua, that he defcribes under the
appearance of " two tubercles, confiding of a white and glandular fubftance,
" of the figure and fize of the teftes •, rifing up equally above the foramen,.
" within the bladder-, yielding to a fyringe when introdue'd, but falling im-
" mediately back into their former fituation when that was withdrawn ;" as.
you have it in this twenty-fourth fection of the Sepulchretum (z).
Thefe two tubercles Terraneus. (a) would never have taken for Cowper's
glands (which he fuppos'd to be difcover'd by him) fwell'd to a confiderable
degree, if, when reading Bartholin, he had taken notice that they were found.
" in the bladder." But it is probable that he did read the paffage : and I wifh
this was the only thing I could accufe him of; fince being defirous of col-
lecting obfervations from any author, and tranferibing them, he has told us
(.•) N. 17. (y) IV. Animad. 14..
(«) N. 6. (z) Obf. 12. §. 9.
(it) Supra, ad n. 17, (a) De Glandul. c. 5,
that
Letter XLII. Article i, 2. 469
hat this obfervation of Bartholin is to be found " in century the firft, hiftory
4 the twenty-third •," whereas ic is really to be met with in the fecond century,
hiftory the fifty-fecond.
But if thefe tubercles had grown out from the proftate gland, as their na-
ture, colour, and fituation, demonftrate •, and, as the two others, which I
have already defcrib'd to you (/>), in fome mealure (how; I have alio a recent
example of this gland beginning to (hoot out, into two caruncles, within the
bladder. But this example, as for another reafon it belongs to the next let-
ter (f), I will delay to produce till then. And that letter will be long> in the
fame proportion as this is ftiort. Farewell.
(i) Epilh 39. n. 33. (c) Vid. n. u.
LETTER the FORT Y-S ECOND
Treats of the difficulty of making Water, the Ardor-
urinae and other Diforders in which the Urine is con-
cern'd.
I Am going now to give you a long letter; as I intend to comprize therein,
every thing that remains among the obfervations relative to diforders
wherein the urine is concern'd, made by Valfalva or by me. What follows
is from Valfalva.
2. A knight of fix and forty years of age, who had been formerly fat, but
was now (lender, and of a yellow complexion inclining to palenefs •, had be-
gun to be troubled, eight years before, with many and various difagreeabk
lymptoms, on account of many and various errors in his diet, exercife, at-
tention of mind, watching, and venery.
Firft of all, being infected with the lues venerea, from lying with an in-
fected woman, he was feiz'd with a gonorrhoea •, which being cur'd by a pro-
per medical regimen, was fucceeded by another more violent one, from the
fame caui'e.
For befides »he pain in making water -x an involuntary difcharge of the
urine, a purulent fediment thereof, a pain of the ftomach in like manner, and
vomitings-, by means of which he fometimes threw up veal, that had been,
eaten five days before, without any change ; were exceedingly troublefome.
Being
470 Book III. Of the Difeafes of the Belly.
Being freed from all thefe complaints by the help of remedies, he was at-
tack'd a third time, with the fame kind of gonorrhoea, and from the fame
caufe •, the diforder being attended with fpafmodic pains in making water, and
continual watchings. Befides thefe fymptoms, he had certain tumours of the
condylomatous kind, within the extremity of the inteftinum rec~lum -, from
which, for fome weeks, and even for fome months, blood was difcharg'd
every day, to the quantity of five or fix ounces : fo that the patient was al-
ready redue'd to fuch a date of weaknefs, as to fall into fwoonings whenever
he attempted to walk.
To this flux of blood was join'd a diarrhoea ; by which a yellow matter,
and, fometimes, a matter of a different colour, was difcharg'd. This diarrhoea
continu'd quite tothe day of his death: being at one time more mild, and at
another time more violent ; as the purulent iediment of his urine did alfo ;
and the frequent difcharge of his urine attended with pain, which difcharge
was likewile almoft always involuntary : but if the urine ftagnated a little
time in the bladder, by reafon of the tenacious ftate of the matter, it excited
a mod fevere pain ; especially while the difcharge thereof was attempted.
With all thefe different fymptoms was he troubled for many years : his
pulfe being always quick, frequent, and turgid ; though the other figns,
which confirm the prefence of a fever, were wanting. About fifteen days;
only, before his death, having fat up very late, and indulg'd himfelf in play-
ino- at dice; whereby he loft a considerable fum of money; he was fo af-
fected therefrom, both in body and mind, that he went to bed with a vo-
miting and a fever, which began with a flight fhivering and a heavy pain in
his head.
In the mean while, the fediment of his urine was increas'd : and the pains
in making water were increas'd : and thefe pains becoming ftill more and
more violent, excited a fingultus. Yet even this was appeas'd after many
days: puftules, in the mean .while, breaking out about the lips, and probably
about the fauces alfo ; as a pungent pain therein, a difficulty of fwallowing,
and a vifcid and tenacious fpitting, feem'd to fhow.
An itching, moreover, in the fkin of the loins, which had been flight for
about two years, exceedingly tormented the patient at times, for fome weeks
before his death. Finally, the fingultus returning, and the ftrength of the
patient failing every day, he died convuls'd.
The thorax being open'd ; in confequence of his having had a difficulty in
lying down on one fide on the laft day of his life •, the lungs were found to be
found: if you except fome very fmall ftony concretions that fcarcely deferv'd
norce.
But when the belly was open'd, the kidnies appear'd to be lefs than their
natural fize, of an unufual kind of figure, and to have many protuberances
.here and there externally. Thefe tubercles, when cut into, fhow'd a fanious
humour for which a paflage was open'd into the pelvis. But in the urinary
bladder; in which, particularly about its neck, the root of the difeafe was
fuppos'd to exift, by the unanimous con fen t of many learnefl men •, nothing
appear'd in any part that was worthy of remark, except a kind of flight ero-
sion about the orifices of the ureters.
a. Valfalva
Letter XLH. Article 3, 4., 5. 47 1
«. Valfalva fuppos'd, and with very pood rcafon, that this diffection mij
be a leffonoffome importance; as it might make us cautious in determining
the feats of difeales, when they relate to the urinary parts: the diagnoOs of
which, even when enquir'u1 into with the greattit ikill, and accuracy, is very
frequently deceitful ; as it was in this cafe, and in another alio, whereof] re-
member him to have given me the relation in this manner.
4. That a certain perlon labour'd under a difordcr of his urine, and the
parts ferving to the fecretion thereof; was evident to every body. Yet h J
complain'd very little of the kidnies, or of the region of thefe vilcera; but,
on the other hand, was tormented with fuch pains in the bladder, that five
or fix phyficians, not of the mcaneft clafs, did not doubt but the feat of the
dlfeafe was in the bladder.
When his body was difiected after death, not the lead dilbrder appear'J
in the bladder; but there were large and ramifying calculi in the kidnies.
5. I faw thefe calculi, which Valfalva kept by him.
And both of thefe hiftories brought to memory a third, which you will find
transfer'd, from Harderus, into the Section of the Sepulchretum, which re-
lates to the Subject in queftion ; that is into the twenty-fifth (a). The cafe is
of a boy of three years old ; but, although he difcover'd, by his geftures,
the moft violent pain in making water -, he notwithstanding did not ever fhow
any figns of pain in the kidnies that I read of.
i omit to take notice that this boy alio, as well as that knight (b), had a
perpetual diarrhoea ; puftules not long before death, and even convulfions in-
death: for fome of thefe may be from different caufes in different perfons.
This circumftance, however, I attend to, " that nothing preternatural?
" could be obferv'd in the bladder:" but that in one of the kidnies there had
been not only plenty of fmall fandy particles, included in the carunculas pa-
pillares; and particularly, that before the mouth of the ureter, there had been
" an oblong acuminated calculus, of the hardnefs of a flint, and tenacioufly
*' wrap'd up in membranes ;" or, as Harderus himfelf explains it in the fcho-
lium, " intangled in very thin membranes of the kidney ;" which u he wa3
** oblig'd to feparate with a lancet."
. Whether, therefore, an irritation be propagated from the kidnies to the
bladder, by the continued membranes of the ureter ; as I have already laid on
a former occafion (c); which is the moft fenfible where it terminates ; or rather,
whether in thefe cafes, fmall particles of fand, or as the firft hiftory, by a
flight erofion about the orifices of the ureters, feems to fhow, acrid particles
of matter defcend into the bladder ; they fo vellicate this vifcus by Stagnating
there, that the moft fevere pains arife : and particularly while it is conttricted,
in order to difcharge its contents.
At leaft a very aTid matter, flowing down from the corroded kidnies into •
the bladder, had fo affected this refervoir, and the neighbouring parts, in a-
certain man, that the pain in the loins not continuing constantly as it did in
the bladder, and bringing on " all the fymptoms of a calculus confin'd there-
*' in, there remain'd no doubt of the actual exifter.ee of this calculus" in the
•
(a) Obf. 10. (c) Epift. 40. n. 5.
{$) Supra, n. z.
2 breaf*
472 Book III. Of Difeafes of the Belly.
bread of his phyfician, who was the celebrated Hottingcr (d). Yet of fudi
a calculus was not the leafl trace found after death.
And that you may the more and more underftand, how eafily we may fall
into errors, in determining upon the caule of a dyfuria-, turn to the hif-
tories of two matrons : the one given by Schrockius (e), the other by Bon-
figlius (f).
The firft was tormented with a tenefmus, with pains in the pubes, and a
kind of milky urine ■, the fecond had been afflicted with a dyfuria from her
very infancy, with urine fometimes of the fame kind ; to which, at laft -,
many fmall foliated membranes, as it were, " were added :" which had not
been difcharg'd without the fenfation of a very heavy weight, a pain, and an
ardor.
Yet in neither of them was found any difeafe of the bladder •, but in the
fecond, one of the kidnies was internally difeas'd, and prolaps'd from its
feat, in confequence of its bulk being increas'd : and in the firft was a large
fcirrhus, which, occupying almoft the whole pelvis, and growing to the
fundus of the bladder, lb comprefs'd this refervoir, that the acrimony of the
urine, retain'd thereby, gave the mod excruciating pain.
6. Valfalva very folicitoufly enquir'd after another caufe, whereby the
bladder may fometimes be vellicated : but he could never confirm the exift-
ence of it by dilTeclion •, I mean of worms refiding in this cavity. I know
however, that worms, difcharg'd together with the urine, as the patients and
their domeftics imagin'd, have been more than once offer' d to his infpection.
For I was at Bologna, when a gentleman ; v/ho, after pains of the kid-
nies, and a fucceeding fenfe of pricking in the bladder, finding, at length,
that his urethra was prick'd in the fame manner, at the time of making water-,
faw a kind of (lender animalcule fall from the urethra, together with his
urine : and foon after, examining the urine he had difcharg'd, he not only
faw this one in the chamber-pot, but even many other animalcules of the
fame kind, together with fandy concretions; which appearances he fhow'd
to Valfalva, who was his phyfician.
Valfalva had happen'd, at that time, to give the patient liquor in which
the root of faxifrage had been boil'd : he therefore order'd them to be taken
out of the urine, living as they were, and thrown into a glafs of this decoc-
tion ; from whence they loft their vivacity, became ftupid, andieem'd almoft
dead, yet, after two days, having fhaken off this ftupor, they were thrown
into feveral different waters, for the fake of experiment-, in each of which
waters, different ingredients, fuppos'd to be inimical to worms, were boil'd,
and agitated -, but none of thefe waters was obferv'd to affect them fo much
as the former, except one, in which not only fuch things as are fuppos'd to
expel fand, and gravel, had been boil'd, but even quick-filver had been
agitated.
Thefe animalcules were black ; and, in fome meafure, fimilar to thofe
worms that we fee in dry wood : which circumftance, at length, put Valfalva
upon inquiring whether others of the fame kind couid not be found m the
patient's bed-chamber, or where the chamber-pot was at any time kept.
(rt) Eph. r.. c. Dec. 3. A. 9. & 10. obf. (e) Earund. cent. 1. & 2. obf. 1 86.
:-,2. {/) Earund. cent. 9. obf. .}..
: And
Letter XLII. Article 6. 473
And thcfe animalcules being actually found, there was an end to all his
experiments : yet he did not feem entirely to have laid down his former fuf-
picidn •, efpecially as other animalcules were brought to him, which were
laid to have been diicharg'd in the urine of another patient, together with a
fabulous matter.
One of thcfe Valfalva fliow'd to me-, and took care that it fliould be drawn
to the life, even by the help of a microfcope : yet I fhal! fay nothing upon
the fubjecl i fince Alghifi, in his letter to Vaflilheri (g ), has told us what ap-
pear'd to him from hence : and has, at the fame time, given a figure of the-
animalcules : and Vallifneri has fuppos'd he might fufpecl from hence, that
they were the oft-fpring of thofe black flies, or worms, which make their
niduiTes in timber •, and that they had happen'd to fall from the ciclings into
the chamber-pot : for thus he wrote to me on the fourth day of April in
the year 1 7 1 1 .
But the fame Vallifneri feems, fince that, in an annotation (b) to the letter
of Alghifi, to be almoft inclin'd to believe, or, at leaft, fulpect, that fome
very fmall, and almoft, invifible worms ; which he at that time faw in the
tirine of a man, who was his patient ; might have been generated within his
body.
This therefore being, at prefent, the ftate of the queftion ; fince Vallifneri
did not, as far as I know, determine any thing, afterwards, for certain, in
regard to thefe worms-, it is proper that we alfo fhould withold ouralTentin
the mean while •, either till chance prefents us with more certain appearances,
or the fkilfulnefs of fome gentleman, extremely well vers'd in the hiftory of
infects, fuch as the celebrated Reaumur is at this time, fhall make deeper re-
fearches into the fubject.
For as the ftudy of natural hiftory, and that of infects in particular, is
carried to fuch a height of improvement in our age, phyficians have been
thereby render'd the more cautious in giving credit to obfervations of this
kind. See, for inftance, the great number of hiftories*which are related by
Johannes Rhodius (7), and Dominicus de Marinis (k).
Out of fo great a number of worms, which were formerly faid to be dif-
charg'd by the urethra, we fhould, at this time, immediately know that fome
were nothing elfe but polypous concretions in the fhape of worms ; that
others were real worms indeed, yet had not fallen from the urethra, but,
externally, from fome other place, into the chamber pots •, inafmuch as they
were of that kind which cannot be generated within the body, nor live
therein : or if they did really come from the urethra, it would appear that
they were not generated in the urinary parts, but in the inteftines which had
been perforated ; from whence they had crept into the bladder, or urethra :
the paflages being open'd by abfeeffes, and by fiftulas in particular.
An example of this laft kind is pointed out by Vallifneri (/) : and Alghifi
( m) relates another of his own, that he was afterwards better acquainted with,
•
(a) Quam vid. torn. 1. hujus Operum, p. 5. (&) Diflert. de remontlr. a Capture. & cxt.
(.0) Ibid. (/) Adnot cit.
(;) Cent. 3. Obf. Med. 35 & 36. (m) Loc. cit.y
Vol. II. P p p from
474 Book III. Of Difeafes of the Belly.
from direction •, which confirm'd him in his opinion of the cafe (*). You
have, alio, in the Sepulchretum (o), more than one exampte of perforations
of this kind : and if, in theie patients, round worms, or afcari&e,s, came forth
by the urethra ; there was nothing therein which could greatly excite our
wonder.
But when, in this twenty-fifth fection (/>), vou read of the diflcction of a
man, who had, while living, difcharg'd two afcarides in his urine j and that,
in his bladder which was ulcerated, one worm was found, " like thole that
. " are found in putrid fiefh ■" you mutt hefitate, and doubt whether there
was not fome finus, which had been unobferv'd, going from that ulcer, and
reaching to the intcftinum rectum : and whether the afcarides had not pafs'd
over, from thence into the bladder-, or rather whether thofe afcarides •, altho'
they had been found by the patient, himfelf, " in a living and active ftate,
and creeping upon the glans penis, itfelf ;" had neverthelefs not come from
the urethra, but from the anus, together with fome part of the excrementitious
matter •, and by this means had crept on to the penis.
But in regard to that worm which was quite of another fpecies, and which
was found in an ulcer of the bladder •, if however it was a real worm ; and
taking this for granted, if not carried thither by fponges, or fome other acci-
dent •, you may fuppofe that it was brought forth by its mother-fly, near the
external orifice of the urethra, which was infected with a putrid ichor : and
that it had crept through this canal quite into the bladder: but that this
had happen'd after the patient's death, and not while he was yet living.
For neither would the fphin&er of the bladder, unlefs quite relax'd, have
fuffer'd any thing to have accefs to the cavity thereof; nor would the man
have fail'd to feel the motion of this infect creeping through the urethra ;
unlefs quite deftitute of fenfation ; and in confequence thereof would have had
a ftimulus to make water : and by this means, the animalcule mult have been
thrown out, together with the urine, immediately, as foon as ever it had en-
ter'd the urethra : aad I am furpriz'd that Ruyfch did not fufficiently attend
to this (^), when he fuppos'd that worms might creep, from their lurking-
places, through the urethra, quite to the neck of the bladder, and remain
there till they put on the form of nymph* ; on which fuppofition another
very great difficulty, in the opinion of Vallifneri (r), offers itfelf to our con-
fideration.
7. What then ? you will fay, among all the many examples that Georgius
Francus (j), Rofinus Lentilius (/), Mich. Fr. Lochnerus (a), have reckon'd
up, do not fome, at lealt, occur, that are plac'd beyond all poflibility of
doubt ?
I am not at leifure to examine them all. But this I can fay ; that many of
them are of the fame kind with thofe fpoken of before : and as they were all
read over by Vallifneri •, for thofe volumes, wherein thefe enumerations are
contain'd, were publifh'd many years before his death, and perus'd by him ;
(>/) Vid. Benevoli Oflerv. 8. (s) Eph. n. c. dec. 3. a. 4. obf. 2.
(c) Seft. 27. 1. 3. obf. 1. (t) Earund. cent. 1 & 2. Append, n. II.
(/>) In Additam. obf. 20. ad obf. 14.
(q) Thef. Anat. 1. in fine. («) Earund. cent. 8. obf. 99.
(') Adnot. cit.
2 he,
Letter XLII. Article 7. 475
he, rwverthckls, found no inllance whatever, among them, as far as I know,
from which lie thought it neceflary to change his opinion entirely.
He did not call into question the credit of the authors who had written ;
hut, in fome he wiih'd for a greater lhare of fagacity, in fome more dilig
and in others a prudent method of lufpeCling and doubting ; fo that, unlcK
they had eonlider'd all the fymptoms which had preceded, all which attended,
and focceeded, they fhould not fuppofe themfelves to have made a fufficieni
enquiry. After his death other examples came forth 5 one of which it ap-
pears had been communicated to him.
But he certainly could not have read thole that are extant in the Commer-
cium Litterarium (»). And if he could have read them •, he, indeed, without
doubt, would have paid great deference to the illufhious and every way re-
lpeclable obfervers, as I myfelf do ; he would, nevertheless, probably have
wifh'd, that almoft all of them, in general, had not happen'd in that fex
which is fo prone to deceive ; a circumftance that is taken notice of by
one of the obfervers •, and, in like manner, that the worms had been
defcrib'd in fome •, in fome that they had been really feen alive •, and in others
that both the delcription, and the reprefentation, had not naturally given us a
fufpicion of polypous concretions.
For you know how lufpicious he was in making his own obfervations •, and,
if you pleafe, even difficult. However, in judging of the obfervations of
others, he has had Daniel le Clerc ( r), for a follower of his morofe cautiouf-
nefs •, and even Lochner (z) himfelf, and his friend Godfrey Thomafius {a).
But thefe authors, you will fay, except to fome only, of the many oblerva-
tions, wherein worms are faid to have been difcharg'd from the urethra. Nor
do I obftinately deny them all. I only wait for fome perfon to confirm, by
his more clear, and lefs exceptionable examples, fome obfervations on which.
I have lefs hefitation.
But if thefe obfervations feem, to you, to be plac'd beyond all doubt, you are
at liberty to admit them for me •, fo you do but confefs, that thefe appearances,
which were then fo frequent, and almoft innumerable, according to this fup-
pofition, are now redue'd to a few, and happen but feldom. And this will
appear fo much the more ftriking, if we confider thofe which have hitherto
been examin'd by difledlion. What was more fimilar to a worm, than that
which the celebrated Kneller {b) has defcrib'd, as being thrown out of the
urethra, after very violent pains of the urinary paflages ? But when a more
accurate examination was made, he himfelf found that what he had taken
for a worm, was nothing elfe but coagulated blood, furrounded with a kind,
of (lender coat.
And even thofe which were difcharg'd in a very great number, by a man
of diftin&ion, through the fame paflage, " were fully and perfectly like" the
round worms of the inteftines •, as the accurate delcription of Thomafius (c)
mows : fo that " the rumour, of To unufual a thing, was fpread abroad
(x) A. 1731. Spec. 27.11. 5 ; & a. 1734. (z) Obf. 99. cit.
hebd. 39. poft. n.4; & a. 1735. hebd. 36. n. (a) Obf. 100. feq.
3. & a. 1743. hebd. 49. n. 3. ut omittauir a. {i) Acl. n. c. torn. 5. obf. 7^.
1745. hebd. 4. n. 2. & cait. (fj Obf. cit. 100.
(y) Hilt. lat. Lumbric. c. i^.ubi. deVermib.
cum Urina Excret.
. P p p 2 *' through
476 Book III. Of Difeafes of the Belly.
" through the city, quick almoft as thought." The nidus of which worms,
being inquir'd after in the dead body, in the other parts deftin'd to the offices
of excreting the urine; it was at length found, from the ftate of the left kid-
ney, and its ureter, that they had been nothing more than inanimate con-
cretions of fasculent and vifcid blood, collected together in'thefe pafiaores,
and difpos'd into that form.
And when true worms had been difcharg'd from the bladder, Alghifi
learn'd from difiections •, as I have faid above (d) •, and another author refer'd.
to by Vallifncri, that is the celebrated Reinholdus Wagner (e), learn'd alfo
by diffection ; through what paffages they had come thither from the in-
terlines.
But now let us, at length, go on from a doubtful, or at leaft, very rare
caufe of a dyfuria ; I mean worms generated in the urinary organs ; to a ma-
nifeft and very frequent caufe-, that is to a ftone of the bladder: although,
out of two diflections which I find, and no more, in the papers of Vallalva,
of thofe that were affected with this difeafe •, as I have given one of them al-
ready, in confequence of its having a more immediate relation to the apo-
plexy (f) ; one only remains, which relates to calculi of the bladder, and to
their unfuccefsful excifion at the fame time.
8. A boy, of nine years of age, had already labour'd for fix years, under
a calculus of the bladder. He was much troubled with it at intervals. He
frequently difcharg'd his urine involuntarily, and mix'd with certain filaments ;
yet that fluid was of a natural colour : unlefs when it fometimes became
bloody from too great motion. The calculus fometimes could be felt by the
finger, when introdue'd per anum, and at other times could not.
And a lithotomift having undertaken to extract this calculus ; after having,
troubled the boy for a long time, drew forth a fmall ftone with great force.
And when he perceiv'd that another ftone was contain'd in the bladder, he
again tortur'd the boy to fuch a violent degree,, that he faid his pain was fo ex-
cruciating as to fuffbeate him : at length he extracted a portion of thefraclur'd
ftone.
Scarcely half an hour was elaps'd, when the boy began to vomit ; com-
plaining continually of a very great pain in the lower part of his belly. To
thefe fymptoms was added a flight tumour of the abdomen : and a fever at-
tended by a great thirft ; together with fome difficulty of breathing, and a
toffing or the whole body. He therefore died one and twenty hours after the
extraction of the calculi.
His belly being open'd, the bladder, with its furrounding membranes,
was found to be inflam'd ; and about the cervix, on the anterior part, lace-
rated. In the cavity of it remain'd one half of the fecond calculus.
9. The unfkilfulnefs, or rafhnefs, of the lithotomift, in this cafe, certainly
cannot be excus'd. Nor do I fay this, becaufe, when his finger was intro-
due'd into the anus, he fometimes could, and fometimes could not, perceive
the calculi : for, in regard to this circumftance, we (hall confider it pre-
fently (g).
{d) N. 6. (f) Epift. 4. n. 2,
\e) Eph. n. c. cent. 1 Sc 2. obf. r;c. (g) N. 10.
But
Letter XLII. Article 10, 477
But I fay it for this realbn, that it is certain he muft not have made a fuf-
ficient opening for extracting the calculus; as Ik- extracted a fniall ilone
with a very great force: tor which realbn the very circumftance Cel us (I)'
has warnM us of, happtn'd with very ill cohfequences j 1 mean that ""the
" calculus, when taken away with force, makes a paffage for itfelf, if a pal
" fage be not already made:" and thus; although, in children, the parts
more eafily yield to dilatation, which is one of the realons why lithotomy is,
for the moll part, more fuccefsful in this age, than any other; in this cafe the
bladder was, nevertheless, lacerated about its cervix.
Add to this the tedioulhefs, and great painfulnefs, of the operation ; and
the breaking afunder of one of the ftones ; though we do not read of its being
large; which probably would have have been by no means nccefiary, if the
paffage had been made fuificiently wide ; and which ought always to be
avoided if there be no necefiity : left either the forceps mould hurt the in-
ternal coat of the bladder, by intercepting it, or the parts of the ftone, by
flying afunder, fhould injure this thin membrane : or left, while they are
fought after by a long examination, and drawn forth, they give occafion of
injuring the parts : or finally left any fragment of them, being left behind,
fhould afford a new beginning to a calculus of the bladder.
If Hippocrates had forbid fuch a lithotomift as this, and others like him,,
from " cutting perfons who labour under the ftone ;" this palTage of his from,
the little book intitled Juflurandum, or the oath, would not have been fo
tortur'd.
But he forbad his difciples this, and commanded that " they mould give
" place to men who were employ'd in furgery in the performance of this
" operation ;" could he mean becaufe he thought that the practice of fur-
gery did not become a phyfician ? As if he himfelf were not very much
vers'd in the practice of it ; or was it for fear he fhould expofe his difciples
to the (lander, and contempt, of thofe who were only exercis'd in the cure of
diforders of particular parts ?
I fhould fuppofe fo if, befides this one difeafe, he had likewife order'd the
fame thing to be done in other diforders of fome certain parts. Why then did
he except this one cafe only ? I am rather inclin'd to be of opinion with thofc
who fuppofe it to be excepted, as being liable to the moft confiderable danger
among the others ; and particularly at that time, when fo many admonitions,
precepts, and inftruments, whereby the operation might be brought very
near to its perfection, as it is in our days, had not yet been added. But lee
us return to the lithotomift of whom I had begun to ipeak.
10. As to his fometimes feeling, and fometimes not feeling, the calculi by
introducing his finger into the anus, the caule of this circumftance may be
manifold : nor does this happen lefs frequently to fkilful, than to unfkilful.
examiners.
The celebrated Jo. Anthony Galll certainly was, and is, a very fkillful
phyfician and furgeon ; in which Ja.it capacity he was particularly famous :
fome years ago, this gentleman had been fenr for from Bologna to Faenza,
at the fame time that I was alfo fent for from Forli, where I then happen'd to
(b) De Medic. 1. 7. c. 26. f. 2.
% be,.
47* Book III. Of Difeafcs of the 1 lly.
be, to fee a man of fome eminence, who was affected* with mutt of thofe fymp-
toms that generally attend a ftone of the bladder,
THis experienced fufgeon, by introducing his finger at tha. time, could by-
no means perceive the ftone, which he had perceiv'd before -, yet we did not
conclude that there was no ftone, for this reafon, as the iympcoms ftill con-
tinued. And we did not even conclude fo afterwards, when they feem'd to
have vanifh'd.
Tor I was inform'd by the patient; about a month after that day, when
the gout, (to which he had formerly been fubject, and after that had not
been any more troubled with, for a long time) had return'd upon him fud-
denly, and all the difagreeable fymptoms of his bladder had gone away at the
fame time ; that he therefore did not doubt but I fhould come over to his opi-
nion as he wifh'd: I mean that all the fymptoms of which he had complain'd
to fo great a degree, when I was prefent, had not been owing to a calculus,
but to a gouty matter irritating the bladder.
I anfwer'd him, however, ftill in this manner ; that as I had not pronoune'd,
from the fymptoms whereof he complain'd before, that he certainly labour'd
under a calculus, becauie he had not been willing to admit of the catheter-,
from whence, perhaps, an undoubted fign of its exiftence, would haveoffer'd
itfelf in the founding of the ftone againft the catheter ; fo neither could I,
from the obfeurity of thofe fymptoms ; which perhaps was owing to the urine
being become lefs acrid, by reafon of the irritating particles being then car-
ried to fome other part ; for a certainty deny that there was a ftone : not even
if the catheter were introduced, and no found could be perceiv'd.
For I. was not ignorant that fome lithotomifts, while I flood by them, and
even that Cheflelden himfelf (/') as well as others, have not been able to per-
ceive the ftone ; even after three times introducing the catheter : notwith-
standing one was really in the bladder.
And in fact, when I had return'd to Padua, it was fignified to me, in the
name of the patient, that as he was not able any longer to endure the former
fymptoms, which were now return'd-, he had taken care to have the calculus,
which was perceiv'd with the catheter, fucceisfully extracted by incifion.
And indeed that very experiene'd man Morand (k) has hinted, that pains
of the bladder, from a calculus,- fometimes lie dormant for many months
together; and even for years : and you have in the preceding fections of the
Sepulchretum, from Tulpius (l)> and Nafius (m), examples of thofe perfons ;
one of whom, " for the fpace of five yeans together," and the other " from
" childhood, quite to the age of five and thirty," had little, or nothing, of
thefe very troublefome fymptoms, of a ftone in the bladder remaining : not-
withstanding they had been before afflicted therewith, and had, even then,
large calculi in their bladders •, fo that the firft of them, like our Faventinus,
believ'd that he never had a calculus.
I take no notice of others, who, never having made any complaint of this
dileafe, had, after dying in a decrepit old age, either large calculi, or a great
•number of them, in the bladder ; to the aftonifhment of every one: to whole
(/') Vid. Morand. Mem. de l'Acad. R. des (I) Sett. 24. obf. S.
Sc. A. 1740. (m) Sed. z--,. obf. 7. §. 4.
fJtJ Ibid.
three
Letter XLII. Article 10. 479
three hillorics, that are in 1 ke manner defcrib'd in the Sepulchretum («), 1
might add others' ; and in particular two from Alghifi (0J1 one of which, by
realbn or* the perforation in Ik- middle of the (lone, is Grnilar to the third of
the former hiilorics, which has Loll" us for its author.
And in the year 1752, v. hen I was teaching anatomy in the college, a per-
forated ftone was brought to me, in the pr< enc< of many peribns, by art
eminent apothecary, whole- fhop is under the college -, which Hone was fimi-
lar to that reprefented by Alghifi (p), except that the foramen was fomewhat
more narrow. He told us that it bad been dilchargM, fome days before, with-
out any other afliftance than that of nature, and the hand ot the woman her-
fclf, in whole bladder it bad been form'd.
And I fuppos'd that this calculus, and every other of the fame kind, if there
have been any beiide that ot Alghifi, had been form'd in the fhape of a ring,
in the lower part of the bladder, about the orifice of the urethra -, where the
upper part of the proftate, or, in the female lex, the corpus glandofum, as
it is call'd, is fometimes fo prominent on the infide of the bladder all round,
that the neighbouring parietes of this receptacle fubfide thereabout. Which
prominence, and fubfiding •, though in the moll: healthy bodies, as I have
laid in a former work (j), they are generally found to be inconfiderable, or
fcarcely obfervable ; may neverthdefs, at other times, be fomewhat larger in
different bodies,
The fabulous and vifcid particles, therefore, remaining behind after the
laft drops of urine, may fometimes, in thofe who abound therewith, concrete ■
by degrees in this fubfiding part •, and receive an annular form therefrom, as if
cad in a mould 5 be there increas'd, and flagnate ; till an unufual fituation,
or motion, of body, or fome other caufe, may diflodge it from thence, and
raife it up : and fo by accident pufh it into the urethra, which in women is
generally pretty wide and dilatable, as happen'd to this woman ; and that
with fo much the more eafe, as the circumference of the ftone approach'd,
in fome meafure, to an elliptical figure -t one extremity of which was a little
narrower than the other.
The patient, by whom this ftone had been voided, was a virgin of eighty-
two years of age : and fhe had never been admonifli'd by any pain, or trouble-
fome fenfation, that fhe labour'd under a calculus of the bladder ; except that
fhe had remark'd her urine to have been difcharg'd in a more flender, or
thread-like ftream, than ufual -, till the calculus, having fallen into the ure-
thra, excited pains of a Hidden, and thefe brought on efforts of expulllon :
fo that within half an hour's time it was already prominent, and could be laid
hold of with the fingers and taken out : no inconvenience whatever, as the
patient herfelf, who had related all thefe circumftances, affirm'd, being left
behind. i •
Yet the foramen, although it tranfmits the urine, does not always prevent
the uneafy fymptoms ; as it certainly did not prevent them, in the cafe of a
light and rou:,d ftone ; and one of the fame weight with that of Lofllus ; in a
merchant whole hiftory (which is altogether worthy of being transfer'd into
{n) Ibid. §. 5. & 7. & fetf. 24. obf. 9. (j>) Tab. 3. fig. 9. _
(e) Litotom. c. 4. \q_) Adveif. 3. A;»lmad. 41.
the
480 Book III. Of Difeafes of the Belly.
the Sepulchretum) Charles Patin (r) took care fhould be publifh'd, almoft
at the fame time, both at Padua, and Noremberg.
And left you fhould fuppole this to have happen'd, becaufe the canal was
not hollow'd out in the middle, but through the anterior part ot the (tone-,
firft turn to the account of that very great (lone, in the Afta Eruditorum L:p-
fienfia (s), from which, " befides a certain heavy pain in the inguinal region,
" the old man, though eighty years of age, had fcarcely perceiv'd any dif-
*• order •, as the urine, which was carried to the bladder, flow'd through a
" canal, form'd on the furface of the ftone, from the ureters immediately to
" the cervix of the bladder."
And, on the other hand, fee in the acts of the Caefarean Academy (/),
what another patient fuffer'd; notwithftanding on the furface of the calculus,
which (luck in the neck of the bladder, "certain finufTes were hollow'd out,"
that " the urine had kept open, like natural paffages," through which to dif-
charge itfelf.
And indeed, that you may not afcribe fo great an efficacy to the paflage left
through the middle of the calculi ; read, in Contulus (*), the diffedtion of
the Cardinal Franzofi, who, by a very regular method of living, was pre-
ferv'd almoft for the fpace of thirty years, fo as to reach his eighty-fixth year :
but " many times was he troubled with calculous, and urinary diforders •,"
although the calculi of the bladder " reprefented a circle, when combin'd
" together :" that is left a chink in the midft of them, as the figure fhows,
" through which the urine pafs'd down."
Then, finally, attend to what I heard from Vallifneri. There was a gen-
tleman at Padua, of the noble family of Mantua, an intimate acquaintance
of Vallifneri's, who had been troubled with mod of the fymptoms, of the dif-
eafe I am lpeaking of, to fuch a degree, and for fo long a time-, that if, be-
fides thefe fymptoms, any impediment to the difcharge of the urine had at
any time come on, every phyfician would have agreed in their opinion of his
cafe ; and pronoune'd that he was afflicted with a ftone of the bladder.
But many were of a different opinion, for this reafon, that he always dif-
charg'd his urine without any difficulty, even when in a (landing poflure.
His bladder being examirrd after death •, as he had order'd when living; in
it were found three fmooth calculi, of a roundifh figure ; and for this very
reafon, leaving a triangular foramen between their fides, when plac'd near to
each other : wherefore, although the urine pafs'd through the middle, and
the calculi were of fuch a figure, and fuch a fmoothnefs, as I fee made ufe of
to account for other patients not being troubled with difagreeable fymptoms
of a calculus •, yet in this gentleman, certainly, they were the caufe of many
and very confiderable inconveniencies •, as they were alio to the merchant of
Patmus.
But thefe cafes which I have refer'd to fince thofe two firft of Tulpius, and
Nafius, J have mention'd only for the fake of companion : becaufe, whether
they were, or were not, attended with any uneafinefs to the patient, in almoft
(r) Vid. in Lyceo Patav. ejus Yitam. & Eph. (t) Tom. 4. obf 49.
n. c. dec. 2. a. i. obf. 19. (;<) De Lapid c. 25. & in cake libri.
[i) A. 1685. Tab. 5.
all
Letter XLII. Article n. 481
i\)\ of thefe the calculi could be perceiv'd nevcrthelefs, upon the introduc-
tion of the catheter -, but not in the two fir It : as they were not obvious, but
hidden in a diverticulum of the bladder, which was form'd upon the fides of
it : of the origin of which diverticulum I lhall have a better opportunity of
(peaking below (x).
But it is* Efficient to have hinted at it here-, that you may, even from
hence, underltand what deceptions may arife to patients themtclves, and to
lichotomilts 5 if the calculi, which were before in the bladder, happen to re-
cede into a facculus of that kind, from whence they may, according to the
various pofition, and motion, of the patient, return back again into the blad-
der.
For it will happen, not only that out of many lithotomiits, one may per-
ceive the itone, and another may not •, but that the fame lithotomift may
perceive it at one time, and not at another : and the patient, who before
complain'd of a tenefmus, from the weight of the ftone forcing againft the
re<ftum that lies beneath it, like a quantity of harden'd excrement •, and who
fek, at the time when the bladder conftri&ed itfelf, in order to difcharge the
urine, great pains from the roughnefs of the ftone irritating the bladder ;
and from thence, likewife, a troublefome obftrudtion, which oppos'd itfelf
to the courle of the urine •, will, when the ftone has been diverted into a la-
teral facculus of the bladder, feem now to himfelf to be quite free from all
thefe fymptoms and every thing elfe of the kind : and even quite releas'd
from the difeafe.
But of calculi more hereafter. For if I am to go on from hence, to fub-
join my obfervations, in the fame order that I have related thofe of Valfalva j
I muft, of courfe, begin with that which relates to the dyfuria, when brought
on by a diforder of the kidnies in particular : of which kind is that I promis'd
you in the latter part of the former letter (y).
11. A man of fixty years of age, had lain for fome months, in this hofpi-
tal, on account of a ferous infarction of the thigh, and left knee : nor did he
return home after this tumour was difcufs'd ; being detain'd, at firft, with a
dyfentery, and after this with a flight inflammation of one eye: and finally,
when this reafon, for his ftay, was remov'd alfo, he neverthelefs ftill remain'd
on account of his indigence ; which was fo much the greater becaufe he was a
great eater, fo as not to be content with the food given to perfons on their
recovery, but to be perpetually alking for more.
This man was therefore carried off, in the hofpital, as he was eating, by a
very fudden death ; there being not the leaft fign of any fyncope, or fuffbea-
tion. Nor had he in his long ftay in the hofpital, ever given the leaft fign of
the thorax, or brain, being never fo (lightly afiedted: and all I heard when
I inquir'd from the perfons who had been about him, was that he had been
fometimes heard to complain of a fharpnefs of urine.
And as 1 found the origin of this acrimony fo much the more evident in the
body after death, than I did the caufe of that fudden death which was obfeure ;
I for that reafon thought proper to relate, in this place, rather than in any
other, what appearances prefented themfelves to me, a'lout the fixch day
(x) N. 30. {y) N. 19.
Vol. II. Q__q q ajtef
48 2 Book III. Of Difeafes of the Belly.
after death : for it was not in my power to make any obfervation on them
looner, for reafons that there is no neceffity of hinting at here : yet the bodv
was fo well preferv'd, by means of the cold, (for it was now the middle of
December in the year 1749) that although the inteftines and mefentery were
taken out, the day before I went to examine the body, they not only fhow'd
nodiforder at all, but even did not fmell ftrongly. What other appearances
I met with, take as they follow •, beginning firft with the head.
The left hemifphere of the brain, not only had many of the trunks of
thofe vefTels, which creep through the dura mater, turgid with 'blood, but
alfo fhow'd, in the ventricle that lay beneath it, a water fomewhat turbid ;
not in any great quantity indeed, but in much greater quantuy than in the
right: in both ventricles, the plexus choroides were pale. And although the
medullary fubftance of the cerebrum was fomewhat hard, yet the cerebellum
was very lax.
In the thorax, the pofterior furface of the left lobe of the lungs coher'd
clofely with the pleura : and the edges, both of this, and the right lobe,
ihow'd their veficles to be diflended with air, to a confiderable extc nt. How-
ever, neither the afpera arteria, nor the larynx (which were alio cxamin'd in-
ternally) had any mark of diforder : nor yet the great veflels, nor the heart
itfelf; in which was nothing polypous. Within the pericardium was a turbid
water-, but in no great quantity : and in both the cavities of the thorax, as
in the belly alfo, was fo fmall a quantity, that it did not exceed, in all, more
rhan a few ounces.
Finally, the belly when open'd ; if you except fome of the genital parts,
particularly the urinary paifages, and a few of the arteries ; fhow'd all its con-
tain'd vifcera to be nearly in a natural condition : nearly, I fay, for the liver,
and the ftomach, which was half-full of ingefta, partly folid and partly fluid,
appear'd fomewhat larger than they generally do.
But the trunk of the great artery, where it lay on the vertebras of the
loins, had, in fome places, white beginnings of offification, which the rami-
fications of it alfo had : and indeed it had true bone already form'd ; as I
found in that part, in particular, where the right iliac divided itfelf into two
branches.
As to what relates to the genital parts, the right tefticle was three times
larger than the left. But this was perhaps natural; for both of them, when
cut into, were found to be found. This appearance, however, was from dif-
eafe •, I mean that from the tunica albuginea of both of them, and from the
fame part in both, hung a fomewhat round and very fmall body ; which, al-
though the coat itfelf was white, was of a redifh colour-, the remains, I fup-
pofe, of a foregoing hydatid : yet there was no water within the tunica vaginalis.
At length the internal ftructure of both kidnies appear'd to be confus'd :
nor were fmall cells wanting, full of fluid, one of which ; for the others lay.
hid fomewhat more internally ; fhow'd itfelf partly on the furface. Each
pelvis, after it had defcerwled from the kidney, in a preternatural flate of
diftention -, fo as to be equal, in width, to two inches-, contracted itfelf in-
to the ureter. And the ureters, when they had run almoft half their length,
became wider than they generally are ; and particularly the left, which was
alfo increas'd in its length, by reafon of its flexures. *
5 In
Letter XLII. Article 12. 483
In both of them, you would fuppofe, if you handled them externally, that
calculi were contain'd in fome places, though only here and there. But
when we came to open them, we found, in every one of thele places, an hy-
datid i lbme of them round, others oval ; fringing' from the internal coat into
the cavity of the ureter, and yet not by a fmall Itulk. The round ones were
equal in lize to fmall grapes ; and the oval ones were twice as large as they
longitudinally.
The ureters confided of pretty thick coats, the internal of which was ting'd
with a continual rednefs : and they open'd by more oblong orifices than was
natural, into the bladder. Thisrelervoir contain'd lb great a quantity of urine,
that in the fupine port arc of the body, it extended itielf to the lowed vertebrae
of the loins. And indeed when, after the urine wasfqueez'd out, it was dif-
tended with air blown in ; although it came near to that fhape which was
mention'd, by me, in a former work (z) ; it was neverthelels confiderably
longer than it generally is : however, the coats thereof were not thicken'd,
nor were internally red in any part ; with which colour not even the urethra
was ting'd.
Finally, that which I promis'd in the preceding letter (a), ought not to be
omitted. From the pofterior border of that orifice, from whence the urethra
begins, two white, hard, hemiipherical, prominences, fmall in their fize, but
of equal magnitude, and contiguous to each other, protuberated within the
bladder; in cutting which longitudinally, together with the proftate gland,
I found them to be continu'd thereto, and to be made up of the fame fub-
ftance : and although one part of the proftate gland was not of that white-
nefs and hardnefs ; yet the remaining fubdance thereof, and efpecially that
which rofe up on the (ides of the feminal caruncle, was perfectly like that of
the double prominence, into which it was produe'd ; lb that if thefe promi-
nences were fcirrhous, the largeft part of the proftate might feem to be no
lefs fcirrhous alio.
12. The other appearances that I demonftrated in the brain, the heart,
and the other vifcera of the fame body, which were accurately difie&ed,
do not relate to the prefent fubjed, nor are proper for the prefent occafion ;
becaufe they were not preternatural.
And this being the date of matters, I could not fuppofe the caufe, of fo
fudden a death, to have confided in any thing elfe, but a certain very violent
convulfion of the pia mater-, and this in coniequence of the ferum •, which a
long dagnation in the thigh had, perhaps, render'd very acrid ; not being
diffidently carried off by ftool ; and having, therefore, fallen, at lad, upon
the membranes of the brain, to the utter dedruction of the patient.
But the complaints of the acrimony of the urine, had been of much longer
(landing, in my opinion, than the infarction of the thigh : at lead the origin
of them will, certainly, feem to be of a very ancient date, if you confider the
date of the kidnies, ureters, and bladder.
Thefe parts had, in all probability, been formerly affected, univerfally,
with calculi : that is to fay, the kidnies, by their formation, and increafe •, the
ureters, and bladder, by their various delay in thefe parts •, which, by fym-
(z) Epift. anat. i. n. 61. (a) N. 19.
Q q q 2 pathy,
484. Book III. Of Difeafes of the Belly.
pathv, again injur'd the kidnies, the pelves, and the other parts juft now men-
tion'd : the greater part or' them being enlarg'd, by the retention of urine ;
and the ureters, moreover, being injur'd in a peculiar manner-, To as I do noc
remember to have ieen them in any other iubject ; I mean by having internal
hydatids brought on them, which, even of themfelves, might have retarded
the urine, and, without any calculi, have been the caufe of the greater part
of thole fymptoms which I juft now accounted for from calculi : or, to fay
the lead, might have increas'd every fymptom that the calculi gave ori-
gin to.
But whatever was the caufe that brought on thefe difeas'd appearances, it
certainly is not furprizing, that an urine more acrid than ufual, fhould have
diftill'd from kidnies of this kind : or that, from the glands of ureters of this
kind ; inftead of a humour fit to fmear over and defend them againft the fa-
line particles of the urine ; an acrid humour, or none at all, fhould be
fecreted.
For, from either of thofe caufes, you may account for thefe pafTages be-
ing internally red, inftead of having their natural whitenefs ; and fending
down to the bladder urine that either was become more acrid than uiuai with-
in themfelves, or was at leaft untemper'd with that addition of an emollient
and demulcent nature.
And what I have touch'd upon but (lightly here, you will the more ap-
prove of, if you read thofe writings of our friends Pujati and Benevoli ;
and transfer hither what I have pointed out in the preceding letter (b). For
I muft now go on, in purfuance of the order I profefs'd to obferve, to that
dyfuria which is from calculi of the bladder.
13. Andrew Cortini; a fellow-citizen of mine, father of the very reverend
inquifitor of that name at Ferrara, and the grandfather of Anthony Cortini,
■who is very expert in the chirurgical and pharmaceutical art, and one for whom
I have a great regard ; being of a fattifh habit of body, and but little us'd ta
exerciie, began, after he had advanc'd beyond fixty years of age, to make wa-
ter of a white colour, and of a vifcid nature.
From hence arofe a fufpicion that he had a calculus in his bladder ; which
fulpicion the furgeon, by introducing the catheter, confirm'd himfelf in, but
not the patient : for when the furgeon faid he touch'd the calculus with the
catheter, he, on the other hand, being deceiv'd by the impulfe of the cal-
culus, aflerted that it was not a calculus he touch'd, but the bladder. And
this opinion he was the more confirm'd in, becaufe, from the time of intro-
ducing the catheter, he had found it much eafier to difcharge his urine.
Now therefore he did not complain of this fo much, as of a certain pain in
the fcrobiculus cordis, which, if he walk'd a little more quick than ufual,
oblig'd him to flop. To this was added turgid and vibrating pulfations of
the arteries ; fuch as frequently happen from an aneurifm. Nor indeed did
thefe ceafe, when, after a long interval of time, the difficulty of making wa-
ter return'd, with a fenfe of heat about the pubes. And indeed the complaints
of that pain in the fcrobiculus cordis, were almoft continual : the pulfe con-
tinu'd the fame.
4
(J) N. 12.
Three
Letter XLII. Article 13. 485
Three or four years had pafs'd from the firft beginning of the dyfuria*, and
from the beginning of the other difagreeable fymptoms, at lead two and twenty
months, when I was alio call'd to the patient, before the end of February,
in the year 1711, tocomlort him, as I immediately laid to his domeftics, ra-
ther than to cure him.
He made a much greater quantity of water than he drank: and his urine
was of a yellowilh colour, inclining to white ■, like the whey wherewith a portion
of milk Hill remains mix'd •, a white matter afterwards fubfiding; fometimes
in {mall quantity and thin, at other times in large quantity and thick •, and of
an ill fmell : and this was difcharg'd with a greater degree of pain and difficul-
ty •, as was wont to happen, chiefly, about the morning.
The pain in the fcrobiculus cordis was become fb very violent, that the
patient laid, when it attack'd him the moll leverely, as it did at intervals,
that it feem'd to him juftas if he were torn by dogs: at which time he alfo
iaid that the fternum, and the neighbouring parts, on both fides, were painful j
but that the upper limb, on the left iide, became ftupid, and without fenfa-
tion : and finally, that the heart, elpecially if he lay on the left fide, palpi-
tated to a very troublefome degree.
Thefe fymptoms became more violent every day, fo that the face was no
longer red, in thole exacerbations of pain, as it before us'd to be in general ;
and even the nofe, hands, and feet, were cold : and the inteftines, which it
had been hitherto necefiary to relax every third day, by means of a clyfter,
now difcharg'd a bilious matter after each of thefe exacerbations.
But, left any one fhould fufpecl: that thefe arofe from an irritation of the
bladder ; in proportion as thefe were more heighten'd and fevere, fo much the
more flight was every fymptom about the bladder-, and the urine was dif-
charg'd with the more eafe. Yet you did not, on applying your hand to the
breaft, or the belly, perceive any thing that was preternatural : and even the
belly had no where any hardnefs, nor the leaft tenfion whatever.
In the mean while, his fleep being broken with his pains, his appetite for
food being deprav'd, and a thirft troubling him, his ftrength was more and
more worn out : the internal fenfes began to be torpid as it were -, and
the pulfe itfelf had fo declin'd from that firft magnitude, and impetus, as to
become fmall and weak (elpecially on the left fide) and frequently unequal,
and this alfo particularly on the left fide : but in the laft exacerbations there
was no pulfe at all perceiv'd.
In this deplorable (late of things then, I did not omit to give all the eafe
in my power, though I could do nothing by way of radically curing the dif-
orders. But all the remedies I could try, though they had no bad effects,
had no good ones neverthelefs. On the eighth of March therefore, two or
three drops of blood having fallen from his noftrils fpontaneoufly •, and he
having fpent the following night worfe than ever, from the frequent attacks
of pain in the fcrobiculus cordis ;. and having, nevertheleis, rais'd himfelf to-
fit up in bed in the morning, when the pain was gone off-, the fame pain re-
turn'd about an hour after : and raging very violently carried off the unhappy
patient, 1 had almoft laid, fuddenly.
The thorax of this body, which was, even then, furnifh'd with a pretty
large quantity of fat, being firft riiiTec'ted ; we found the lungs, the heart,
and
486 Book III. Of the Difeafes of the Belly.
and the large v'eflels, to be quite free from diforder. The belly contain'd a
liver which was not of a natural colour : the gall-bladder was contracted and
flaccid •, in confequence of the pains, of which I have fpoken, having fo
many times prefs'd out the bile. The fundus of the itomach, which was in
other refpects found, fhow'd a flight appearance of blacknefs.
The left kidney •, being almoft univerlally confum'd in its internal fub-
ftance, and extremely flaccid •, contain'd an unequal calculus, and urine like
that which the patient had difcharg'd. This, kind of urine was alio found in
the right kidney : the external furface of which was divided into a great num-
ber of rifing globules, as it were, of an unequal magnitude among them-
felves.
The bladder contain'd three (tones, which were neither rough nor large.
The internal furface of this cavity feem'd to be made up of a kind of t omen-
tum, or tow, and grew out at the fide of the cervix, into a hard tubercle,
not larger than a bean ; and of the fame colour with the bladder, both inter-
nally and externally. Finally, in the proftate gland was a finus, wherein a
matter fimilar to tartar, and already almoft calculous, was contain'd.
14. In this patient, the caufes of the dyfuria, which is the fubject of our
prefent letter, were contain'd in the proftate gland, the bladder, and thekid-
nies : but the caufes of thofe very violent pains, whereby he was tortur'd to
fuch a degree, and at length deftroy'd, lay, as far as I can conceive of the
cafe, in the kidnies. For it is not probable that thefe pains were excited from
the lower parts of the belly -, efpecially as there were very great diforders in
the kidnies, with which no body can be^ ignorant to what a great degree the
omach confents, the right fide of which anfwers to the fcrobiculus cordis.
And to this confent are we to impute the vomitings that are, generally,
join'd with diforders of the kidnies. You will therefore remember that, in a
very obfeure cafe {c ), I fufpedted thefe diforders to exift from the actual exift-
ence of thefe vomitings.
There had alio been very great vomitings, in a virgin, who was kill'd
within the fpace of two days, by an excruciating pain under the left ribs •, ow-
ing to an occult diforder of the kidney, as I have defcrib'd in the thirty-fixth
letter [d). Yet it has ibmetimes happen'd, that considerable diforders of the
kidnies have lain hid (e), without any vomiting, and without any, or, at leaft,
with very flight marks, of the kidnies being difeas'd •, or that they have im-
pos'd upon phyficians, for diforders of the bladder, which was entirely un-
affected (f).
Finally, it is certain, that with diforders of the kidnies, a pain of the fto-
mach is ibmetimes join'd ; but not one that is mortal, or disjoin'd from a pain
of the loins ; which every one knows to attend, in general, upon diforders
of the kidnies, that are affix'd thereto : and thefe either not fevere, or fome-
times violent, as I have related in another letter (g) from Ruyfch, when he
iaw the furface of the kidnies divided into globules, juft as I obferv'd it to
be in the right kidney of this patient.
However, in this cafe of ours there was no complaint of the loins •, no ve-
ry fevere pain in the bladder ; no excruciating tortures of the hypochondria;
(c) Epifl. 30. n. 22. (f) Vid. fupra, n. 4& 5.
{J) N. 20. (j) Epift. 40. n. 19.
'■) Epift, 40. n. 1 5.
no
Letter XLII. Article 15, 16. 487
no vomitings ; but intolerable pains at the fcrobiculus cordis, were the only
figns of" the kidnies being affected with difeale.
You will perhaps afk, whether this circumftance has been obferv'd by other
authors : it certainly fo much the more deferves to be notie'd, as it may the
more caule a lufpicion of other difeafes; efpecially if, as in the hiftory bro-
pos'd, it follow after large and vibrating pulfes ; and bring on the trouble-
lome palpitation of the heart, a fhipor, and torpor, of the upper limbs, and
at length death itfetf : and that even almoft fuddenly, when the patient leems
to be lomewhat refrefh'd.
For 1 have already admonifh'd {b), that this is to be fear'd, when violent in-
ternal convulllons recur at intervals. To which kind of diforder, I fuppofe the
exacerbations of pain I have defcrib'd to belong: and I account for them from
the very great irritation of the nerves in the kidnies ; fo that being propa-
gated by means of the other nerves communicating therewith, to thofe parts
which I juft now mention'd, it produces, in each of thefe parts, the effects
I have fpoken of.
This fingular circumftance attended our cafe, that the ftomach, which is, as
I have already taken notice, generally attack'd by exacerbations, proceeding
from the kidnies, was not, as ufually happens, excited to vomiting •, not-
withstanding that part of it, which anfwers to the fcrobiculus cordis, was
very feverely tortur'd.
15. A young man, who had pafs'd his twentieth year, had been tortur'd,
for a long time, with fuch pains of the bladder, efpecially when he made wa-
ter, that he could not difcharge his urine without crying out. His urine was
purulent. An emaciated ftate of body, a fever, and other diforders, which
generally accompany a ftone of the bladder, had come on ; and by thefe
he was, at length, carried off in this hofpital, before the end of the year
1742.
The bladder, which was thicken'd in its coats, ulcerated, and, in part,
fcirrhous, actually contain'd a ftone which was fomewhat rough on the out-
fide, and three inches in length ; being two inches and a half broad, in the
broadeft part of it : it was alfo nearly of an oval figure, and deprefs'd on
both fides ; and in fome places a great quantity of tough and bloody mucus
adher'd round about it. The kidnies, and the ureters, were full of pus, and
urine •, and the ureters were even diftended to fuch a degree, as to equal the
diameter of the inteftinum ileum.
16. The mucus, which we faw adhering to the calculus of this young
man, is fometimes gathered around it in fo great a quantity, that the ftone
cannot be diftinguifh'd, even by introducing the catheter •, a circumftance
which happens to the molt experiene'd men •, and which, as Marcellus Dona-
tus teftifies (*'), happen'd to Falloppius himfelf.
By this mucus, when gather'd round the calculus, betwixt that and the
bladder; though it does not tend to remove the other fymptoms, and even
increafes fome ; the pains, neverthelefs, which are created by the roughneis
of the calculi, are diminifh'd : and particularly if the mucus is very thick,
and in great quantity.
{h) Epift. 10. n. 13. (?) DeMed. Hilt. Mirab. I. 4, c. 50.
Hence
488 Book III. Of Difeafes of the Belly.
I Icnceit is that the pains are increas'd by diuretic medicines (which I fuiJ
alfo of nephritic cafes) as our Sanctorius confirm'd by a very clear example,
that is transfer'd into the Sepulchretum, in the preceding twenty-third lec-
tion (k) ; where you will alfo read that of Donatus (I).
Wherefore, in opinions which I have read, Valfalva prefcrib'd, in cafes of
ftone in the bladder, demulcents, emollients and anodynes ; and applied them
in the form of fomentations, fleams, and fmall glyfters ; and to women even
in peflaries and injections : but as he, in conjunction with Albertini, difap-
prov'd of narcotics ; becaufe they did not act with any advantage, in very
fmall dofes, againft pains of this kind, and very large dofes were dangerous :
fo alfo they difapprov'd of the drinking of bath-waters, or any other waters in
large quantity •, which has been propos'd by others •, fearing left the mucus
we have fpoken of mould be wafh'd away. On which fubjects I remember to
have heard them both fpeak, many times, to the fame purpofe ; but parti-
cularly when the mafter of the horfe drank the water of Nocera, in pretty
large quantity, every morning.
That this gentleman had an ulcer in his bladder, no body doubted, and
Valfalva ft ill lefs than others •, as he did not believe it was always necefTary
that blood fhould have appear'd in the urine, in order to induce him to pro-
nounce that there was an ulcer in the urinary paflages. One thing however
was a matter of controverfy •, I mean whether, befides an ulcer, there was a
calculus in the bladder. This was afErm'd by fome, on account of the pain
which had already been long perceiv'd in the end of making water.
But Valfalva and Albertini withheld their afTcnt •, well knowing that an
ulcerated bladder could not, more than an ulcerated hand, be contracted, and
conftring'd, without pain : and this they knew to be the reafon why the
bladder, when thus ulcerated, like other hollow parts, which are under a
necefTity of being dilated at one time, and contracted at another, are with
great difficulty brought back to a found ftate.
Yet they did not contend that no calculus was in the bladder ; although
the patient, either in dancing, or riding in a coach, experiene'd no fymp-
toms of it ; nor yet, while he difcharg'd his urine, perceiv'd a very fevere
pain at the end •, but fuch a one as he again began to perceive, when he had
at length difcharg'd as much as he had drunk.
However, although they neither afErm'd, nor denied one or the other, yet
Albertini feem'd to me, in fome meafure, inclin'd to believe that there was
no calculus ; fince, by fo plentiful a drinking of water, the mucus muft have
been taken away from the ftone, and the troublefome fymptoms, confe-
quently, daily increas'd by this means: and, on the other hand, he conceiv'd
that while the water was pading, the ulcer and pains might be mollified, and
aflwag'd thereby ; and that thefe pains did not return to their former feverity,
before the urine began to recover its former acrimony, after the difcharge of
all the water.
But left you mould think this hefitation in affirming, or denying, the exift-
ence of a ftone in the bladder, was too cautious in fuch men as thefe ; or
thofe of equal eminence with themfelves ; I beg of you to read what has been
(4) Obf. 4. §. 11. (/) Ibid. §.4.
excel-
Letter XLII. Article 17. 489
excellently well collected, and confider'd, by Helwich (m), among others, of
the very great difficulty of properly determining fuch a qucftion : the more
you (hall be dilpleas'd by the head-long ralhncfs of fome others, the more
will you commend the prudent cautioulnels of thefe gentlemen.
1 7. That I do not here add other dilTections, of thofe perfons in whom a
ftone has been form'd in the bladder, without any external caule, will not be
furprizing to you •, as you know, that the greateft part of my life has been
fpent in this country, that is, like fome others •, among which thole or Schat-
luufen (t:)y and Gottingen (<?), are commended ; very little liable to that dil-
order : and this circumftance fome think is owing to the wines, fome to the
waters, and others to both of them.
Certainly, the wines in this place are not tartareous, to fpeak in the lan-
guage of phyficians: that is to fay, they do not cover over the cafks, inter-
ually, with itony crufts ; as I have feen in fome other places where they make
white wines : fo that a caik of ftone feem'd to have been form'd within the
wooden cafk.
But the wines that we make ufe of here are red : which wines Brunne-
rus (p), indeed, thought " affected the head, and the upper parts, more than
" the white i" yet, on the other hand, his father-in-law, Wepfer^J, whole
opinion is commended by Hoffmann (r), afcrib'd it chiefly to the falutary ef-
fects of their red wine, that calculous diforders were very rare among his fel-
low-inhabitants of Schafhaufen.
And that red wines are produe'd, in fome places, which not only preferve
from the ftone, but even diflblve it when begun ; inafmuch as they even dif-
folve the tartar, wherewith other wines have incrufted the cafk, into which
they are put ; you will learn from the Commercium Litterarium (s).
Moreover, in regard to the waters ; the water of the rivers in this coun-
try, with an equal part, or fomewhat more, and even fometimes a much
larger quantity, of which the mult (from whence the wines generally us'd in
this country are made) is preferv'd ; contains, perhaps, lefs earth, as is gene-
rally faid ; or at leaft lefs of the matter fit for the generation of calculi.
And 1 fpeak thus generally, becaufe it is necelTary to attend to a great num-
ber of different circumftances, and make many minute examinations, before
any thing certain be pronoune'd of every one river in particular: although,
for the moft part, lefs earth is found to be contain'd in river-water, than in
well-water ; from whence it happens that we fee the former fit for many do-
meftic purpofes, for which the others are not, or at leaft not equally •, as, for
inftance, that of dilTolving foap, and boiling beans or peas : and as to the
queftion of wholefomenefs, who can doubt but that the water of rivers, and
fountains ; which the will of almighty God has caus'd to offer themfelves
fpontaneoufly to us for drink ; are, in general, more falubrious than thofe
waters, which necefilty has oblig'd men, who live at a diftance from rivers,
and fprings, to procure for themfelves, by digging deep pits in the earth ?
(/») Aft. n. c. torn. 2. obf. 60. (7) Obf. 39. paulo ante cit.
(//) Vid. Eph. n c. dec, 1. a. 2. obf. 39. (r) Med. Rat. torn. 4. p. 2. f. 2. c. II. §. 2a
(0) Vid. Haller. Opufc. Pathol, obf. 33. (/) A. 1735. hebd. 6. n. 3. & hebd. 17. n.
(/) Eph. cit. cent. 9. obf. 3. in not. 4- & pra;fat. in not. ad pag-. 43. & 132.
Voi,. II. R r r And
4^0 Book III. Of the Difeafes of the Belly.
And if the opinion of the mod learned men is alfo to be attended to, fee
what Mead (/), and Platner («), think of well-waters : if you fuffer yourfelf
to be perluaded by their judgment, which is certainly fuppurted by many dif-
ferent reafons, you will not hefitate greatly to prefer river-waters to thofe of
wells ; fpeaking of them in general.
But if the queftion be of particular waters •, there certainly are rivers to
which you would prefer a very good well -, and ftill more another river. For
you know, that the waters of certain fountains, from whence rivers, at length,
have their origin, are thofe that incruft their canals, fome with very thick and
hard earthy lamina;, and others with thin and fofter laminas.
And thefe few things I have hinted at here, that you may refute the vulgar
error of thofe who imagine that all calculi are owing to the cuftom of drinkino-
wine, or fuch like liquors : as if there were not, even in water, a matter of
that- kind ; and they who had never drunk wine never generated calculi. At
lealt he who is fpoken of in the preceding twenty-third lection of the Sepul-
chretum(#), " had made ufe of water-drinking only, through the whole
" courfe of his life •, yet his " bladder contain'd two and thirty ftones."
But why do we inquire after examples of this fact in human creatures ; fince
many of the like kind are to be met with in animals who never drink wine.
For to omit the more fpecious examples ; either on account of their weight ;
as that ftone, for inftance, which weigh'd almoft two pounds, and which be-
ing taken from the bladder of a man, Lemery brought to the Royal Academy
of Sciences at Paris (y) •, or on account of their colour-, as feven or eight very
fmall ones which Vallalva formerly fhow'd me, and which were taken from the
bladder of a cow, having the form of pills, and being of a furfacc that was
rough with very fmall granules, and of a brafs colour; fo that any who did
not know them to be light, would have taken them for metallic bodies, as he
would have done for golden ones, thofe greater numbers of calculi, that were
ting'd, both internally and externally, with a golden colour, and all of them
fmall, which others (z), in like manner, found in the bladders of oxen ; to omit
thofe therefore, and thofe found in a fow (a), and others, and to take notice
of them only in dogs ; and, in the firft place, thofe feen by me in a bitch,
that I diffected when I was a very young man, for the fake of exercifino- my-
felf in anatomy \. I not only found calculi in both kidnies, but I alfo found
that the right kidney did not retain even a third part of its fubftance : whereas
there was a purulent matter among the calculi.
And in another bitch, of a considerable age, that I formerly open'd at Pa-
dua, for the fake of experiment, I found a calculus, within one of the kid-
nies, of an irregular and deprefs'd figure -, hard in its fubftance, and not
fmall in its fize. And to return to the bladder ; the third bitch (for it acci-
dentally happen'd that thefe five creatures, the calculi of each of which I have
mention'd in particular, were all of the female fex) had two ftones in its gan~
(/) Expof. Median. Venen. tent. 6. in fin. marolog. c. 14. §. 8. vid. & apud Haller. ad
(u) Progr. quo aquam font, falubrior. & Boerh. Meth. Stud. Med. p. 13. c. 2. ad an.
cat. 1665. n. 101.
(x) Obf. 4. §. 2. (a) Sachs c. cit. 14. §. 6. & eph. n. c. cent.
(/) Hift. a. 1700. obf. anat. 14. 7. obf. 7.
\z) A£L n. c. torn. 8. obf. 2. & Sachs Gam-
grenous
Letter XLIL Article 17. 491
grenous bladder •, a larger and a fmaller; both of them of an oval figure,
but very much deprets'd on both fides : and even one furface of the lefier was
fomewhat excavated lo as to receive the larger.
This bitch was eleven years of age, and had, for a long time, difcharg'd
a very ill-1'mclhng urine; yet without bowlings, I fuppofe on account of the
fmooth furface or' the calculi, which, for that reafon, did not prick the blad-
der at leaft •, till, at length, ilie was carried off by convulfive motions, where-
with (he had been feiz'd. This relation I rcceiv'd from the matter of the
dog (who was one of the philofophers of this lacred college) attiie lame time
that he fhow'd me the recent calculi.
And calculi have been met with in lb great a number of dogs, by others,
that unleis I felect thole only, which, either their number, their ftruclure,
weight, or fuuation, make more worthy of being notie'd ; I fliall not foon
come to a conclulion. In a dog, which had long labour'd under a dripping
of urine (£), '* fome thoufands " of fmall calculi were found " in the dil-
" tended bladder." The bladder of another (r) contain'd one, which, by
reafon of a leffer that was included within it, reiembled an aiites, and was ?
pound and a half in weight.
But the bladder of a third (d) ; which often difcharg'd its urine with pain-,
and a vehement howling •, contain'd a calculus of a rough furface •, and not
fmooth as in the bitch I open'd at Padua ; and although it was fomewhat lei's
in weight than three ounces, yet you will wonder more at this than at tha'.
which weigh'd a pound and half: for this dog was very fmall in its lpe-
cies.
Finally, to defcribe the fituation, rather than the calculus ; that ought not
to be pafs'd by, which a worthy young gentleman, who was a pupil of mine,
told me, fome years ago, he had found in a dog which he differed for the
fake of exercifing himfelf in anatomy. The ureters, a little above the place
where they open into the bladder, both of them join'd together into one ca-
nal ; which was not wider than either of them when feparate : this one canal,
which is a very extraordinary inftance, perforated the bladder in the middle of
it, and at the lower part ; and thus ferv'd inftead of the two ureters, which
ufually carry the urine into this cavity.
At the beginning, then, of this canal •, where the ureters, as I have already
faid, join'd together •, he found a calculus flicking, which was not very hard.
Yet all thefe examples, and much more the other inftances which Donatus
(<?) has collected ; of calculi found in the liver alfo, or the gall-bladder, ai
well as in the ftomach, and inteftines, of brute animals ; are not to be ob-
jected, in the manner Donatus has done, to Ariftotle-, when he lays (/) " that
" no animal but man can become calculous j" for he has immediately ex-
plain'd this, in fuch a manner as to fhow plainly, that he meant to fpeak there
only of calculi in the urinary bladder.
And in another paffage (g), which it is furprizing fhould efcape Donatu?,
he has exprefly laid, that, in victims, " the kidnies" were {een. " very frc-
(5) Earund. dec. 3. a. <j & 6. obf. 260. (<•) C. cit. fupra ad n. 16.
(c) Ibid, in append, fub n. 6. ad obf. 23. {/) Sert. 10. probl. 42.
(</) Dec. ead. a. 9 & 10. obf. 170. \g) De Partib. Animal. 1. 3. c. 4.
R r r 2 " quently
492 Book III. Of Difeafes of the Belly.
*' quently to be fill'd with calculi, with lacerated membranes and tubercles,
" and even the liver and other parts.
1 8. And from what Ariftotle has laid in another place (b) ; " that not on-
" ly a humour deicends into the bladder, but fome dry concretions alfo, from
" which calculi may be form'd " we underftand the moil ancient origin of
the opinon of thofe, who afferted that the beginnings of all calculi, of the blad-
der, come from the kidnies ; and that in thefe calculi, for that reafon, a pe-
culiar nucleus is always found in the center.
And although I do not deny but both of thefe circumftances are true in
many perions, yet I (hall fometimes be more ready to join with the opinion
of Hippocrates (7), who has taught us that this happens from the urine being
very long confin'd •, whereby that which is the mod thin part of it, is dif-
charg'd : " but that which is mod thick, and turbid, is heap'd up together,
" and concretes •, and at firft, indeed, is fmall, but afterwards becomes
" larger : for while it is roll'd about by the urine, whatever is thick and
" compacted together, adapts itfelf thereto, and by this means increafes it,
<; and forms one general concretion."
And that this may happen very foon, appears from the obfervation of
Joannes Doteus (k), wno aiTerts that a white mucilaginous matter, dif-
charg'd from the bladder of a certain knight, "had been fuddenly harden'd
" into a yellowifh calculus ; from being expos'd to the external air."
But that the urine, by ftagnating within, may become putrid, even with-
out the contact of the external air, appears from the experiments of the cele-
brated Brendelius (I) ; who deduces, from the putrefaction thereof, the origin
of calculi: as he fees (m) that it produces both hard crufts, and a mucous
pultaceous matter, diftinguilh'd with hardifh granules ; which itfelf alfo grows
hard foon after.
And that there are urines which depofit thefe particles fooner, and more
readily, he does not at all doubt (#), where he mentions the cafes of two in-
fants-, one but juft two days old, and the other about eight-, who not
only difcharg'd calculi before death, but had calculi found within them when
dead.
And what kind of calculous matter Mead faw (o), in the carcafe of a boy
of five years old, and by what degrees heobferv'd it degenerate into a ftony
hardnefs, you may learn from himfelf : as you may alfo, from the celebrated
Mailer (p)> what he fuppofes to be the firft beginnings of calculi in the kid-
nies.
But whether the incipient calculus, or the matter of the calculus, defcend
from the kidnies into the bladder, or be generated in the bladder itfelf;
there is no doubt but the calculus has its increafe from the fame matter :
nor do they feem to advance any thing contradictory to truth, who fay
that the particles of this matter will be more firmly adapted to each other,
in proportion as the increafe is more flow ; and lefs firmly, in proportion as
the increafe is more fpeedy : and they feem to be nearly in the right, who
(Z) Hift. Animal. 1. 3. c. 15. (/,;) N. I.
(;') De Aere, Aquis &c. n. 22. 23. (/.) N. 2.
(I) Eph. n. c. dec. 3 a. 4. obf. 64. (a) De Imp. Sol. & Lun. c. 2.
(1) Progr. de calculi veiicx & cxt. Natalib. (p) Opuf. Pathol, obf. 34.
n 2.
fuppofe
Letter XLII. Article 19. 493
Juppofe that this increafe will be greater in Cummer, than in winter; as
in rummer the calculous matter is much lefs diluted by the watry mai-
ler, which then goes oft", through the fkin, in a very confiderable portion :
and this feems to me another re.ilon why, if it is in our power to choofe, the
excilion of the calculus flioukl be put oil* from autumn to fpring, rather than
from fpring to autumn.
Yet belides the beginning of the calculus, form'd either in the kidnies, or
in the bladder, the lame matter adheres round about other things alfo, that
are introduced into the bladder from without. But as many examples of this
kind have been written and collected by many authors, I fhall infiit chiefly on
thofe which I myielf, or my friends have teen •, and yet ihall not deicribe
them all nevertheless.
19. For the firft that offer'd itfelf to me, is that which was publifh'd three
and forty years ago, in the Epbemerides C<rfare<e N. C. Academic* (q). And in-
deed, befides that of mine, another defer ipt ion is alio extant of the very fame
cafe •, by one who did not know that mine was publifh'd : this fecond descrip-
tion was publifh'd fixteen years after, in a certain annotation join'd to the
works of the celebrated Vallilheri (r) ; who had been prefent, together with
me, while the furgeon perform'd the diffeftion.
Both the defcriptions, indeed, agree pretty well together in the principal
matters : and if they differ a little in fome things, confider that I certainly-
committed my obfervations to writing on the very day of the diflection, as my
cuftom is. And the calculus, which I ftill preferve by me ; together with the
needle about which it had been accreted ; is certainly not " very hard :.'*
and this the magnitude of it, compar'd with the weight, at firft fight teftifies.
For although it confifts of two parts, each of which approaches to the oval
figure •, and the larger part, within which the point of the needle ; and al-
molt a third part of it, as it is natural to fuppofe ; lies hid, is three inches
long, two broad, and one and a half thick: and the leffer part, which fill'd
the urethra, in the fame manner as you will read in the cafe of another vir-
gin (s), is continued to one extremity of the former part of the calculus, in
fuch a manner, as to lhoot out at the fide of it, and form a right angle there-
with, and equal the third joint of the middle finger in magnitude-, yet both
of them, together with the needle, are below the weight of a phillipic filver
coin.
And that the fubftance of the calculus is, in great meafure, friable (or at
leaft, externally; and its texture fpongy, is confirm'd. even by looking at ir.
For certain thin lamellae have fallen off, in fome places, fpontaneoufly, and
have laid open the fmall caverns that lie beneath : and a pulveriz'd matter,
of a white colour like the calculus, fimilar to that which falls from rotten
willow or withy branches, naturally moulders from the ftone.
And this I was willing to add to the defcription at prefent, as acircumftance
that I could not obferve in the recent calculus ; and indeed not till it had lain
by fome time.
This calculus is, therefore, furnifh'd with fuch cortices, or fhells, as, if
(0) Cent. 5. obf. 26. (/) Sejuilchret. fe&. hac 25.obf.-5.
(r) Tom. 3. p. 3. OiT. 12,
there
494- B°°k III. Of Difeafes of the Belly.
there had been other harder (tones in the bladder, at the fame time, might
eafily have been broken by the darning of thefe againft them •, and being
fhatter'd into fragments come forth, with the urine, by the fame paffage : as
happen'd in the old man, whole hiftory is given in the Sepulchretum (t)m
from the oblervation of Tulpius.
Nor will you fuppofe the calculus to have been of a much harder nature,
which that very experiene'd man Heifter («)> having prcvioufly perceiv'd it
by the help of the catheter, foon after, by means of fome common remedies,
that he fubjoins, got rid of: for by the ufe of thefe medicines, a great quan-
tity of matter, in the form of a calx, was difcharg'd with the urine ; and
within three weeks, all the difagreeable fymptoms, wherewith he had been
troubled for thefpace of four years, were remov'd : and this cafe he gave the
relation of, when it was now the third year after that fuccefsful cure. And
I could wifh that all the calculi, which are form'd within the bladder, were
of that kind.
But you fee from the Sepulchretum itfelf, how many are faid to have been
of a flinty hardnefs : you even fee, in the fame place (x), that a very large one
is fpoken of, from Heers, as being " harder than any flint ;" and from Bra-
favolus (y) ten, that were found in Albertus Savonarola, which, if they were
thrown upon the ground, rebounded like a ball : and finally, you will find
in Linden (z), that one which can be exceeded by very few in point of
weight, was feen by many perfons ; that is to fay, one which weigh'd thirty-
two ounces, and was " very hard, compact, triangular, and of the colour of
" a flint : and from hence, by means of fteel, fire was drawn as from a flint."
And Panarolus, in like manner, fpeaks of calculi (a)y which were " fo hard
" as to refemble the lapis pyrites ; for when ftricken with fteel, they dif-
charg'd fire :" but thefe I purpofely omit to take notice of, left, as he fays
they were difcharg'd by a woman, you fhould fufpect that he was impos'd
upon ; fince Bartholin (i>) fays that many had conjedtur'd a noble patient,
and his friends, who were prefent, to have been impos'd upon, even in li-
thotomy itfelf, by a crafty juggler-, becaufe fparks of fire were ftruck out of
the falfe ftone ; " and it is impoftlbie that fuch a (tone mould be generated in
" a man;" for which reafon he could fcarcely forbear doubting the hiftory
of another of like hardnefs, which had been given to him, as having been cut
out of the human bladder.
But all thofe that I have taken notice of, from the Sepulchretum, are faid
to have been found in the bladder of bodies after death : and left you fhould
doubt whether there had been any c&ufe of fraud, the firft, at leaft, was
found in an old man, who had never complain'd of a calculus in the bladder;
as another old man never had of his kidnies, who, neverthelefs, had a ftone
in his right kidney, of an unufual magnitude, and figure •, and " in hardnefs
" equal to any flint whatever:" as that celebrated man Chriftoph. Guil. Ba-
jerus (c), who was prefent at the difTe&ion, afferts.
(t) Sett. prox. 24. obf. 10. (a) JatrologiTm. pent. 2. obf. 34.
(«) Diflert. de Medico nimis tim. n. 36. (i>) Cent. 4. Epirt. Medic. 100.
(x) Seel. 23. obf. 7. §. 5. (c) Commerc. Litter, a. 1745. Hebd. 40.
(y) Ibid. obf. 2. §. 4. rt. 2.
(z) J bid. ©bf. 1. §. j. & feft. 24. obf. to.
«• J-
To
Letter XLII. Article 19. 495
To me, however, it has never yet happen'd to have a calculus fhown me,
that coukl be comparM with thele •, unlets bv the fraud of" women, and the
credulity of one or two phyficians, who had been too eafily deceiv'd by
their artifices.
For here I firft faw one, which not only ; to ufe the words of Ferrandus
(■//); " mould be call'd a river- Hone, rather than a calculus of the bladder ;"
but, though it was really a river-flone, was daub'd over with blood, and ob-
truded upon the incautious for a real calculus of the bladder.
And after that I had a letter lent me from Venice, by a phyfician in other
reipedls not unlearned •, in which he told me of a certain woman, who dif-
charg'd, almoft every day, a great number of calculi, and thofe not very
fmall neither : and, in order to gain credit from one who did not eafily believe,
with the letter he lent a great number of the calculi ; on the fight of which I
was immediately ailonifh'd, that there could be any one in the world, who
did not know them to be large, and rough, fragments of the common flint,
which is made ufe of to ftrike fire : however, 1 wrote back nothing elie, but
that I defir'd him to fubject them to a chymical diflillation, and the conie-
quence thereof would fhow the nature of the (tone ; I therefore receiv'd no
more letters from him.
Yet I do not fay thefe things, as if others may not have fecn, in other
places, what I have not feen wherever I have been. And indeed I pcrfur.i.ul
one of my own countrymen, who denied that a calculus could have been ge-
nerated in the human body •, for this reafon only, that it refilled the hammer;.
to attend to the other properties in like manner, and make a diligent in-
quiry ; fince we fee that Steinius is quoted by learned men, as having de-
icrib'd human calculi which refilled the ilrokes of the hammer, in his Litho-
graphia.
And we muft, beyond a doubt, give credit to the very experiene'd Morand
(*), when he afferts that the calculi, which he calls murales, take the lame polifh
as marble : for which reafon he thought them unconquerable, even by that
lithontriptic remedy, which had been, not very long before, made public
among the Englifh •, by means whereof it has been found that feveral other cal-
culi have been either diminifh'd, or confum'd •, and that by the tertimony
even of the catheter alfo in feven : at which Francifcus Sylvius, and Boer-
haave, would have been furpriz'd, had they been living, that this could
be brought about by means of alcaline falts, and even could be brought
about by no other ; for one of them (f) had faid, that this might be effected
•* by rock fait, or the acid fpirit of nitre :" and the other (g), that it could be
" done by fcarcely any other fluid than tiie fpirit of nitre."
But I wifh they could be ailonifh'd that the ufe of this Englifh remedy had
produe'd luch effects in every one, or at leaft in the greater part, of the pa-
tients who had taken it : and, indeed, I wifh that ic had not been burtfuk
But if you confider thofe great number of exceptions, which were afterwards
added; among which are thofe, alfo, that the celebrated Hazonius (b) has
(d) Sepulchr. feft. cit. 23. obf. 2. §. 5. (g) Prsleft. ad Inftit §. 791.
{e) Mem.de l'Acad. R. des Sc. a. 1740. (I) Quclt, de hisEdita a. 4.
(f) Pxax. Med. 1. i.e. 55. n, 50.
&QWfl
496 Book III. Of Difeafes of the Belly.
Ihown us are to be taken from the nature of the calculus, from the age, and
from the temperament, of the patient-, it will appear pretty clearly, how
often this remedy might be either ufelefs or hurtful : and if you read the hif-
tories and diffedtions, which the Commercium Litterarium fets forth (/) •, you
will eafily underftand, how much damage arifes from thence to the internal
parts, and particularly to the urinary paffages : and at the fame time you
will find that there was no erofion of the calculus, or of the calculi, which
would have appear'd from the fediments in the urine.
But while I fpeak this, do not fuppofe either that this erofion, or defqua-
mation, of the calculi ; if we confider every kind of calculi, and every kind
of lithontriptics in general-, is always to be defir'd. You may learn this, not
to turn over other books, from the Commercium already quoted. And where
(k) the examples, and the defections, of two calculous bodies are defcrib'd,
the calculus of the former, " which was widely and deeply eroded in feveral
" parts," deferves to be attended to ; for fome lithontriptic liquor being
given, to which that effect was probably to be imputed, all the fymptoms had
been exacerbated : and the bladder, though not eroded indeed, had been
inflam'd, round the orifice, to a considerable extent.
In another place (/), the cafe of an illuflrious man is taken notice of by
the celebrated Goetzius : wherein he fays that the patient •, having, by the
means of fome remedy or other, difcharg'd in his urine " a very large quan-
tity of fmall fandy particles, and fcales, which feem'd to be the fliell of the
calculus broken down into pieces •," had his pains increas'd to fuch a degree
thereby, that he was carried of in confequence of the exacerbation.
And in the body after death, was found a calculus, " depriv'd of its vifcous
*' and fmooth furface (which had lain in conta<5t with the fides of the bladder
" without any injury) and fore'd, with its very hard, rough, and unequal
" furface, againft the neck of the bladder •" fo that this change, in the ftone,
feems to have excited the violence of the pains : efpecially when we call to
mind thofe things that are faid above (m).
Yet this very phyfician has afferted, that a medicated water, " properly
" prepar'd from the fhells of oyfters, or other fhell-fifh," fucceeds more
happily than that Englifh lithontriptic, which has been diiapprov'd by more
than one very learned phyfician among the Englifh, and particularly by
Mead (n) ; for by the ufe of this water, he fays, " fmall pieces " of not
very hard calculi, " fometimes of land, and at other times of very fmall
" nuclei, as it were, are difcharg'd together with the urine."
He commends the differtation of that celebrated author Robert Whytt,
upon this water. And you will read of experiments made at Helmftad, in
another differtation which was publifh'd in the fame place, under the patro-
nage of the celebrated Krugerus (0) •, by which experiments it appears, that
this water is of an alkali no-fidphureous nature.
(i) A. 1740. hebd. 41. n. 2. & a. 1745. hebd. (m) N. 16.
3- n. 2. («) Monit. Med. c. 10. in fin.
(k) A. 1733. hebd. 21. (0) Diflert. qua exhibentur Expcrim. cum
(/) A. 1731. hebd. 23. aqua Oilrocoderm. inllituta.
4 There
Letter XLII. Article 20. 497
There have been fome alio, who mix'd acids with the alcalies •, and
found, that into the fluid, while thus effervefcing, if calculi were thrown,
they were either entirely, or in fome meafore, difiblv'd : for which reafon
they injected an efFcrviTcing fluid, of this kind, into the bladder of dogs •, in
order to make an experiment how far the bladder could bear it.
Yet although it was born by a found bladder, could it alio be born by one
which is irritated, and ulcerated by calculi? Certainly not-, fince it is found
by the experiments of Morand (p), that, in an ulcerated bladder, the dif-
order is incrcas'd by that former Englifh remedy •, although not in an effer-
vefcing ltate, and diluted by the quantity of urine, wherewith it defcends to
the bladder.
But let us return to calculi which are form'd upon needles.
20. A country-girl, almoft of the fame age with that formerly fpoken of,
by me, in the Ephemerides (q) -, for (he died in her fourteenth year ; hav-
ing done the fame thing as the former, fixteen months before, defervedly
fuffer'd the fame misfortune. For having introdue'd a brafs hair-bodkin,
notwithstanding it was bent in the middle, very high into the urethra, (he
perceiv'd'that it was fuddenly fnatch'd out of her ringers, and entirely hid
within the bladder.
Being reftrain'd by fhame, flie, not only then, but even almoft quite to
the time of her death, was filent as to the true caufe of the pains, and un»
eafinefies, which (lie felt, and particularly in making water -, which were fo
many, and fo great, that a tumour having, at length, arifen in the hypoga-
ftrium, and the neareft part of the ileum, a pus was difcharg'd by two fora-
mina that it had made for itfelf •, one larger and one fmaller ; the former of
which was in the left ilium, and the latter on the right fide ; in that part
which is properly call'd, with Laurentius (V), the fines hypogoftrii.
Being thus affected, fhe was receiv'd into the hofpital at Padua, a month
or two before death. It was there eafily obferv'd, that, together with pus,
urine was pour'd out through each of the foramina, but more through the
left ; under which was a cavity of a pretty considerable fize, wherewith the
right foramen, alfo, communicated.
As, in this cavity, the probe met with fomething hard -, I was afk'd what
I fuppos'd this could be. I immediately call'd to mind what' had refifled the
probe, when it was introdue'd through the fiftula, which had open'd itfelf in
one of the ilia, and had difcharg'd urine with the pus, in the former girl. And
when I heard that this girl was alfo tortur'd with pains of the bladder, in
making water, and that fhe difcharg'd only a fmall quantiiy of urine, and
that purulent ; I anfwer'd that it was neceffary to inquire, whether fhe had
introdue'd a needle, or any thing elfe of the like kind, into the urethra.
The girl denied it; till the left foramen being .enlarg'd, by a flight fection
of the common integuments, the point of the bodkin, and the greater
part of its length, were evidently feen, within the cavity, by every body .
Then what fhe could no longer hide, fhe too late confefs'd. For even the
bodkin could not be extracted, by reafon of a calculus that was form'd upon
it ; which calculus, though it was eafy to perceive it by introducing the probe
(/>) Mem. cit. (*•) Hift. Anat. hum. Corp. 1. 6. c. 2.
(q) Vid. fupra ad initium. n. 19.
Vol. II. S f f through
49 8 Book III. Of Difeafcs of the Belly.
through the pafiage of the urethra, or through that cavity, yet it was im-
poflible to move, even the moft flightly, without great pains.
And the fame calculus prevented their injecting any thing into the urethra,
to afi'wage the pains, by blocking up the pafiage. To thefe iymptoms were
added a very great wafting of fiefh; the quantity of pus was increas'd every
day; and the putrid knell, and the fever, became very violent.
Thefe fymptoms were follow'd by a loathing of all food ; a vomiting, and
difcharge by {tool, of a yellow liquid matter •, a dejection of ftrength,. and
weaknels of pulfe ; till death at length put the wifh'd-for end to To many
miferies and complaints : among which none had ever been heard of a pain in
her loins, by thole who examin'd her upon that head.
The carcafe, which feem'd to be a iceleton cover'd with fkin, was difTected
in the open air, and in a very large place, on account of the time of the year
being very hot} for it was the beginning of July in the year 1738.
I, firft of all, ordered the probe to be pafs'd through the right foramen into
the cavity of the ulcer ; and the whole finus to be laid open. This was be-
twixt the mufcles of the abdomen and the integuments ; nor had any com-
munication, in any part, but with that cavity.
The cavity was in length, and in breadth, three inches ; extending itfelf
from the left ilium towards the linea alba, having a thin pofterior paries,,
which the remains of the mufcles, and the peritonaeum made up, and by
which it was feparated from the cavity of the belly •, but in the fame paries,
which was open on the right fide, it communicated with the fundus of the
bladder : and there a great part of the bodkin was prominent into the cavity
of the bladder.
The abdomen was then cut into, in fuch a manner, that the incifion did
not reach to the bladder : which, although the cavity was fmall, had coalefc'd
pretty high, that is above the os pubis, with the internal furface of the ab-
domen, in that part only where it lay open into the cavity of the ulcer; fo
that nothing could be difcharg'd into the general cavity of the abdomen,
wherein there really was not the leaft extravaiated fluid.
And even the lower border of the omentum, which had fcarcely any re-
maining fat, in moft places, was clofely connected to the neighbouring peri-
tonaeum of the bladder.
Thefe appearances being feen, and the bones of the pubes being drawa
afunder, the whole bladder was difclos'd to view ; and itfelf, together with
the urethra, which was found, laid open : the coats of thefe cavities were
found to be thk^en'd, but fo contracted, that befides the calculus they could
fcarcely contain any thing.
The internal coats of thefe parts, which were unequal, and ulcerated, in
many places, adher'd to the ftone here and there : and were, like the cavity
of the ulcer, in many places gangrenous alfo.
The calculus was a little more than two inches long, being fomewhat
thicker than a man's thumb, and, in its fhape, refembling an egg, the vertex
of which, was turn'd upwards •, as the point of the needle was alfo ; with
all that part which went to the angle whereof I fpoke in the beginning;
being almoft parallel to the calculus, and disjoin'd from it by the interval of
an inch : the remaining part of the needle was, alfo, on the outfide of the
calculus, as far as could be conjectur'd, almoft univerfa41y •, the head only,
5 with
Letter XLII. Article 21. 499
Vuh fome of the neighbouring portion of it, being very firmly infix'd to the
middle and left fide of the calculus; that is, cover'd over with the calculous
concretion ; which portion is, on that lurface, and at both of its extremities, very
unequal-, on the oppofite furface almod fmooth.and lomewhat white ■, except
where it was ting'd of a ycllowifh colour, as the whole left part is ; which
circumltances I defcribt as 1 now fee them; for at that time it was bloody in
fome places, and in others of a dirty brown colour.
At that time alio, the" calculus being examin'd, as it is connected with the
needle, by medical weights, was found to be a few grains lighter than ieven
drams; but now it is a few grains heavier than live drams and two fcruples.
Moll of the other parts of the belly were in a preternatural ftate : their
appearances were as follows. Some of the intcftines were a little livid, and
fomewhat turgid with that yellow humour which was laft of all difcharg'd :
the liver was whitifh : the fpleen was pretty livid, and a little larger than ic
generally is.
But the ureters, and the kidnies themfelves, were in a very bad condition
indeed : for thefe canals were dilated, and full of pus ; of the fame kind with
that which was found in the cavity of the ulcer in confiderable quantity;, for
it was very liquid, and of a yellowim colour, inclining to white : or, in
other words, it was a pus mix'd with urine.
And the kidnies were preternaturally inlarg'd, efpecially the right ; which
was alfo very hard, and internally hollow'd into fmall cells, that were in great
number, and lb diftended with the fame kind of pus, as the pelvis was alio,
that it rufh'd out, to a confiderable height, upon dififection. The adipofe
and proper coats of the left kidney ; being join'd to each other, thicken'd,
and indurated ; confin'd the fame kind of pus betwixt themfelves, with which
the furface of the kidney, that was eroded in fome places, overflow'd s as the
internal parts did alfo in feveral places.
But the very filthy odour, which exhal'd from the kidnies, and the blad-
der, forbad us going on to open the thorax ; no mark ofdifeafe in that part
having appear'd.
21. The difTection being thus finiuYd, you will readily conceive, from what
I fl>all here fubjoin, fomewhat more at large, what I then immediately faid,
according to my cuftom, to the many men of eminence, and others both me-
dical and chirurgical practitioners, and Undents, who heard me.
What reafon could induce this girl, and fo many others, to thruft the heads
•of needles, or bodkins, into the urethra, is not fo much to be inquir'd after
in the lacunas of the falacious humour ; inafmuch as they open in other parts,
and even on the outfide of the urethra, unlefs you, perhaps, fuppole that
thofe canals alfo, which I defcrib'd (s) within the urethra of women, belong
to this clafs alfo ; as in the exquifite fenfe of the membrane wherewith it
is internally inverted.
For unlefs they applied the friction very high up in the tirethra, it could
not happen, that, by a fudden and flrong contraction of the lower part of the
bladder, the needle iTiould be ihatch'd out of their fingers, and be quite bu-
ried in that cavity ; efpecially when the needle is pretty long.
(s) Adverf. i. n. 10. &. iv. Animad, 24.
S f f 2 For
500 Book III. Of Difeafes of the Belly.
For from the bladder, and its fphin&er, I account for this misfortune,
agreeably to the opinion of Molinetti (/) •, and not from a certain power of
the uterus, as they fay, which, even if it had this power of drawing towards
itfelf, would not, however, draw what was thus acted upon, into the blad-
der.
In fome cafes the needles have fallen out, of themfelves, after having been
taken in •, as happen'd to two girls that are fpoken of by Vallifneri (a) : to one
when fhe was afleep, and to the other when fhe was making water : I fup-
pofe, becaufe in thefc they had only enter'd the bladder in part ; that is to
fay, the crooked needle eafily remaining with one part in the urethra, while
the other was retain'd within the bladder for a month.
On this part, however, no calculous matter had been form'd •, as isalfo faid
not to have happen'd to a needle that was thruft in by a fourth (x), and dif-
charg'd after fifteen days, at the time of making water ; which needle it is
probable had been obftrucled, in its paffage through the urethra, at its lowefl
and acute part, from this fymptom ; that fhe complain'd only of a fenfe of
pricking about the neck of the bladder.
But although thefe things that I have faid about the point of the needle,
or bodkin, being fix'd in the urethra, will be more illuftrated by what will
be hinted afterwards (y) •, yet I fliall not deny that needles, which have
been receiv'd quite into the cavity of the bladder, may neverthelefs be fo
turn'd therein, as, in like manner, to be difcharg'd by the meatus urinarius.
But that to thofe two, whereof I fpoke laft, no calculous matter adher'd,.
within fifteen days, and even within the fpace of a whole month, there muft
have been more than one reafon, as we have known this matter to adhere to
others in a much lefs fpace of time.
For the urine, in all perfons, is not equally impregnated with particles fit
to recede therefrom, and generate a calculus : and fome retain their urine
longer than others do ; and the matter, or furface, of different needles is dif-
ferent. Thus Vallifneri (z) has fuppos'd that a filver needle, or bodkin, was.
taken out from the bladder, without the addition of any calculous concre-
tion, merely for this reafon ; that it was filver : which conjecture, however,,
will be much more credible, if it fhall, at any time, be confirm'd by other
experiments.
Thus a concretion feems more likely to adhere to a pretty rough furface,
than to a very polifh'd one : and hence, perhaps, we are to account for this
circumftance, that one part of the needle is, for th^ molt part, cover'd with,
calculous matter -, while the other is left quite naked : of the two girls, there-
fore, whofe bodies I examin'd after death, in the former the head of the
needle, or pin, had perforated the bladder ; and in this other the point •, be-
caufe, in the former, the concretion more eafily gather'd round the lower,,
and perhaps rougher part ; and in the latter more eafily about the oppofite ex-
tremity.
But out of thofe women v/ho have had a needle, which had been thruft into
the bladder •, and a calculus, of a confidcrable fize, form'd upon it ; none,
(/) Diflert. Anat. Pathol. I. 6. c. 8. fy) N. z$. & feq.
(/<) Adnot. ad obf. fuDra ad n» 19. cit. (*) Ob£ cit..
(*) Ibid.
that
Letter XLII. Article 22.
501
that I remember to have read of, carried it for a very long time, yet had the
needle extracted afterwards, and was iav'd ; except that Venetian woman,
whole cafe is publilli'd by Molinetti (a) (under whom me was cur'd in the
year 164.9) wlt^ a 6gurc or tnc needle, and the calculus, added thereto,
which he us'd to fhow in this anatomical theatre, where Moinichenius, in his
epiltle to Thomas Bartholin (^), affertsthat it was leen by him ; for Bartholin
himfelf, as an author in other refpects very learned, has through careleflTnefs
aiferted, could not be ivitnejs to the calculus, which was extracted after he
had departed from Padua, and even from Italy (c).
And this calculus is the fame which is fpoken of by the fame Moinichenius,
in his obfervations (<i) : and this I have hinted at, becaufe, in the latter part of
the annotation to the obfervation of Vallifneri, both of which I have often refer'd
to, it does not leem to be acknowledg'd for the fame, which Vallifneri had
faid was wont to be fliown in this theatre, and is now preferv'd in his mufeum :
for as to his faying, that it was taken from a Paduan, inftead of a Venetian
woman, that I fuppofe was the caufe of the error, which would have been
eafily avoided, if Molinetti had been read, in whofe book he feems not to
know that it is defcrib'd; and I alfo fay that Lanzonus feems to have been
ignorant of it, as he would, otherwife, in his fcholium to that obfervation of
Moinichenius, have been lefs furpriz'd " that a bodkin of bone fhould
*' have lain buried fo long in the bladder, without any injury to the bladder
" itfelf : and even without any inconvenience to the girl."
This the words even of Moinichenius, and much more thofe of Molinet-
ti, did not fuffer him to fuppofe •, not only when fpeaking of what fhe i'uf-
fer'd in the extraction, but alio when delcribing what me endur'd, both be-
fcre, and afterwards.
Yet if the bladder of this girl was much lefs hurt by the needle, than the
bladders of thole whom I have written of-, this probably happen'd becaufe
the point of the needle ftuck longer in the urethra than in the bladder; and
was, at length, pufh'd out of this paflage, by the weight of the calculus for-
cing downwards from above, as Molinetti found it.
22. Thefe calamities, and even death itfelf, may be prevented, by the
perfon, who, being timely warn'd of the cafe, can extract the needle, be-
fore the accretion of any calculous matter 5 and this with fuch dexte-
rity, that the bladder, as far as it is poffible to avoid it, may not be injur'd.
And this has been done with fuccefs, not only by others fpoken of in the
works of Vallifneri (e)t but alfo by two of my friends in particular, whom I
have commended to you already, I mean Marianus and Vulpius.
The former of thefe gentlemen •, as he told me in a letter lent to me in
the beginning of December, in the year 1720-, took out a needle from the
bladder of a country-girl, who already made bloody urine, after having in-
duftrioufly brought it from a tranfverle to a direct: pofition. And it was a.
hair bodkin made of bone.
But that which I faw extracted by Vulpius, from a certain girl of this
(a) C. fupra cit.
(t>) 87. in hujus epift. cent. 2.
(c; Vid. cent, i.epilt. 73 & feq.
(dj Med. Chir. 22.
(<?) Obf. & Adnot, fupra ad n. 21. cit.
city,
5o2 Book III. Of Difeafes of the Belly.
city, was made of brafs. And he had extracted it, a few weeks before I re-
ceiv'd the letter from Mariani, with the ufe of no other inftrument, than
a very fmooth iron wire •, one extremity of which he had fo kicurvated, into
the fhape of a fmall hook, and almoft into the fhape of a ring, that it could
4iot hurt the bladder, and yet could lay hold of the pin •, and would not fuffer
the head of it to flip, when once laid hold of.
However, if the cafe is not known till much later, and a calculus is already
gather'd around the needle ; and this calculus is not of fuch a kind, as to al-
low of its being eafily drawn out, through the urethra ; it will be neceftary,
before the woman be fubjected to the tortures of a very difficult extraction,
to make diligent inquiry, not only whether the bladder, which it is natural
to all to fufpect, but whether the ureters alfo, and particularly the kidniet
themfelves (which fufpicion arifes from our difleclions) have already con-
tracted fo much diforder, that if even the needle and the calculus are taken
away, the woman nruft die neverthelefs.
And the conjecture of the kidnies being diforder'd, will not be taken (o
much from the pains of the loins, (v/hich we have feen may be abfent (f) ;
or, as it probably happen'd in the girl now in queftion {g)y may be obfeur'd
by the much more cruel tortures of the bladder, according to the aphorifm of
Hippocrates (h), as from the fupprefiion of urine in the bladder, which has
ibmetimes preceded, continued for a long time, and been more than once
repeated : or from the very frequent retention to avoid thofe fevere pains ; or
from too fmall a difcharge •, in eftimating which, however, we muft take
care, left we are at any time deceiv'd by the continual dripping of urine •, call-
ing to mind that, with this ftillicidium, a retention thereof may be join'd i
and that in a very great quantity, as I fhall mow when I fpeak on the fubject
of lamenefs (z) : although this has, already, been ftifficiently fhown, even by
other letters (k). And indeed, the Sepulchretum will prefent us with a
hiftory (/), in which you will read that the neck of the bladder was found fo
lax from paralyfis, as " eafily to admit the finger •, for which reafon the urine
** came away, before death, without the patients feeling it : yet the bladder,
" though almoft twice as large as it naturally is, was entirely fill'd neverthe-
*' lefs." And how much the retain'd urine had inlarg'd the ureters, you
have learn'd from thofe letters •, and how much it had, alfo, dilated the cavity
of the kidnies, and had injur'd the fubftance thereof: or in one of them at
leaft.
23. And if thefe things happen from a part of the urine being retain'd j
how much more will they happen from a long, and repeated, fupprefiion of the
whole of it, within the bladder ? Or from a frequent retention both of urine
and of pus ? At leaft you have many examples of this kind, in the Sepul-
chretum, from a fupprefiion •, among which are thofe of Rumlerus (m), and
Ballonius (») •, the latter of whom faw a very inlarg'd ilate of the ureters ; and
the former thefe canals full of urine, and the kidnies of io large a fize, in a
child, as they could fcarcely have had in an adult.
(f) Supra, n. 2. & feq. & n. 13. & feq. (k) Epift. 4. n. 19. & Epift. 39. n. 33.
(g) N. 20. (I) Sett, hujus 3. 1. 27. obf. 2. §. 5.
(h) 46. fe&. 2. («) Seft. 24. obf. iz. $. 6.
(/) Epift. 56.11. 12, {>:) Ibid. §.7.
And
Letter XLII. Article 23. 503
And for this reafon the celebrated Fantonus (0), with juftice, fupposM,
that, where more urine is then drawn off" by the catheter, than the bladder
fecms to contain, " it may partly How down from the diftended meters alio,
and lbmetimes even partly from the inlarg'd kidnies.
That is to fay, when the bladder can now contain no more •, whatever urine
is continually fecreted in the kidnies, firlt diftends the ureters, and after that
the kidnies themfelves alfo. Nor did this efcape Aretnsus (p). " Where
■ the urine is fupprefs'd," fays he (meaning in the bladder) " the fuperior
" parts alfo, that is the kidnies, are fill'd : and the urinary ducts, which the
*' Greeks call ureters, are diftended." And as thefe circumftances happen,
where there is not laid to have been any calculus, before, in the bladder,
and where there is none at prefent •, as may be read in the examples propos'd,
and in like manner in that which is related by the authors of the Commercium
Litcrarium (q), or in the acts of the Crefarean Academy (r), or in the Afta
Helvetica (s) ; for the difcharge of the urine, from the bladder, being hin-
der'd by the abfeefs thereof, or by the coarctation of the paffage through the
proftate -, or the influx into the bladder being prevented, by the very great
diminution of its capacity-, " an inlarg'd ftate of the kidnies, and of the ure-
" ters," or, at leaft, a dilatation of them fo as to " exceed the thicknefs-
M of the little finger, or even equal that of the largeft," immediately occur'd
to the eye ; as thefe things, therefore, happen, even without calculi ; they
certainly ought not to have been imputed only to the obftruction of calculi
in the ureters, which refills the defcent of the urine, by a man in other re-
jects very experiene'd : nor ought it to have been argued, from the circum-
ftance of a certain perfon having only one calculus in the bladder but both
his ureters dilated, that this calculus had neceffarily been made up by the
coalition of two ; one of which had been obftructed in one ureter, and the
other in the other.
But as thofe things, that I have mention'd, happen even where the bladder
may be extended to a very great capacity ; you, without doubt, perceive, how
much more eafily they muft of courfe happen, if the bladder is either con-
tracted into itielf, as in one of the examples refer'd to, or has its cavity oc-
cupied by fome foreign body internally, and leaves but little fpace for the
urine within •, and fometimes fcarcely any •, whether an ifchuria, or a ftran-
gury only, be the confequence.
Thus you have, in the Sepulchretum (7), an obfervation of Silvius, after
an ifchuria, of the ureters " frequently admitting a man's thumb, and con-
taining " urine within them, quite to the kidnies themfelves •" as he fays,
not in the fecond, but in the firft book, of his Praxis Medica, chapter the
fifty-fixth : and you have, alfo, that which is defcrib'd as communicated to
Riolanus («), of the kidnies being " larger than ufual, by one half; fill'd and
" turgid with ferum :" and " of the ureters being very large, and fo diftend-
" ed as to be capable of admitting the little finger, with eafe.
And you will read in the fame place (x), that Cattierus found, after the
(o) Diflert. Anat. Renov. 7. (s) Tom. 1.
(/>) De Cauf. & Sign. Acut. Morb. 1. 2. c. 10. (.') Seft- 24- cIt- obf- 6- §• 8-
\q) A. 1738. Hebd. 32. n. 1. (*) Ibid.obf. 16.
(») Tom. 1. obf. 164. \x\ Seft. hac 25. obf. 8. §. 7.
ftrangury^
504 Book III. Of Difeafes of the Belly.
ftrangury, " the kidnies diftended, and turgid with urine (from which parts
x' when cut into, it flow'd out copioufly) and the ureters very wide :" and
thefe were found to be " very large" by Fantonus (y), whom 1 have already
quoted, even after a dyfuria, from a caufe of the fame kind •, and in proportion
as the dyfuria, like that, is more fevere, it generally has the more violent
ftrangury join'd therewith.
As therefore, in the two girls, whofe bodies were examin'd by me, there
had been a very fevere dyfuria, and the bladder was very much contracted,
and almoft wholly occupied with the calculus ■, it is not furprizing that the
urine, before it could pafs out a little more freely from thence, through a
paiTage made by the needle, mould flagnate in fuch a quantity in the ureters,
and kidnies, as to dilate, and even to vitiate them •, efpecially when mix'd
with the pus, which flow'd from the ulcerated coats of the bladder.
For Euftachius (z), although he affirm'd, that when every thing was in a
natural ftate, " nothing could go out from the bladder, through the meatus
" urinarii," neverthelefs faid, " that he had fometimes obferv'd the contrary
" to happen in many patients, in a great and long fuppreflion of urine."
For the orifices of the ureters being very much inlarg'd alio, together
with the ureters themfelves, where they open into the bladder •, no part of
them now remains to pafs obliquely betwixt the coats of the bladder : there-
fore, not only a portion of the urine may then return that way ; but even,
after the fuppreflion begins to yield, or is already remov'd, the bladder, when
contracting itfelf to difcharge the urine, forces fo much the more of that
fluid upwards, through thole enlarg'd orifices, in proportion as it can expel
the lefs downwards, through the orifice of the urethra, of which the calculus
now and then obftructs thepaffage.
But if it happens that the calculus has made only a flight obstruction
jufb before, and a greater quantity of urine is, for that reafon, difcharg'd thro'
the urethra, fo that but a fmall quantity now remains in the dilated ureters -,
you certainly conceive, that, if the calculus again oppofe itfelf to the urethra,
loon after, the urine, and therewith pus, if it happen to be in the bladder,
may eafily be driven up through the ureters quite to the kidnies •, efpecially
if the patient lies down while attempting to make water.
24. And thefe circumltances are, as you fee, equally common to males,
as to females •, and may, at length, be expected from thefe ftones alfo, which
do nOt form themfelves by accretion round a needle, in the bladder; as
befides that hiftory, of a young man, which I defcrib'd above (*), a great
number of others, fome of which I choofe to take notice of here that you
may add them to the Sepulchretum, demonftrate.
Henricus Henrici, in his diflertation de Abfcejfu Mefenterii(a), fpeaks of
a girl of five years of age, whofe ureter, by reafon of the urine flowing back
into it, on account of a calculus of the bladder, " refembled an inteftine •,"
and the kidney on that fide was three times the fize of the other.
In the Atta Eruditorum Lipfienfia (b), an obfervation is extant, made by
(j) DeObferv. Med. & Anat. epift. 8. n. (*) N. 15.
15. (a) §. 5.
{9) Traa. de Renib. c. ultimo. • {6) A. 1685. M. Mart.
Groenvelr
Letter XLIf. Article 24*
505
Groenvelt on a calculous girl, whole ureters refembled one of the fmall in-
terlines, by their capacity being enlarg'd. Ami Mauchartus (c) faw (he fame
canals (in an old man who had often been afflicted with a (trangury, from
a calculus of the bladder) " inflated like the intelUnum ileum," from urine
like butter-milk, which they contain'd ; at the lame time that the kidnies
were very large and unequal, and had their pehes diftended to the magni
tude of an egg.
Laubius (J) not only faw the ureters very much dilated, together with the
pi'.ves, from the fame difeafe, joinM with the fame fymptom, but alio with
the kidnies difeas'd •, the one labouring under an atrophy, and the other be-
ing large, and ulcerous. After the fame diforders, Lofpichlerus (e) found
the ureters, in a merchant, fo di (tended with the (tagnating urine, as eafily to
admit " the entrance of a pretty large thumb :" and Brunnerus (f) relates,
that, in a man of princely dignity, they were lefs turgid •, but that, the
back part of the kidnies being cut into, " the urine had rufh'd forth in a full
" ftream."
You will perhaps fay, that the diforders, which are fpoken of, in the kid-
nies, and ureters, of thole who are afflicted with a calculus of the bladder,
ought not to be imputed to this calculus, when it is already in the bladder,
but when it ltuck in the kidnies, or the ureters ; and that Butzmann had
judg'd in this manner (g), when, in a child, who had been longtortur'd with,
the diforders we (peak of, he found a facculus full of pus, inftead of the
kidney.
And you will likewife fay, perhaps, that it feem'd to Rudolphus Jac. Ca-
merarius (£), in a little boy, who was affected in the fame way, that the caufe
of a purulent kidney, and of a dilated, and eroded ureter, mould be ac-
counted for in the fame manner.
And indeed, that two obfervations of Cofchwitz (;'), and one of Schul-
zius (k), are extant, in none of which mention is made of a calculus in the
bladder ; but in all of calculous pains : in the two firit, it is alfo faid that the
kidnies were purulent, and that the ureters had been furprizingly dilated :
in the third, it is not only faid that they were dilated, but they are even
defcrib'd, as " writh'd into feveral folds," almoft like the fmall inteftines,
as in the ftable-keeper (I) ; fo great an effect had the urine produe'd, as even
to enlarge the ureters longitudinally.
Yet that the urine had not flow'd back upwards, from the bladder, was
demonftrated by the orifices of the ureters: as both of them in this third ob-
iervation, and one of them in the firft, were (hut up by angular (tones (tick-
ing therein, or fmall teftaceous concretions, as it were, bringing on afpafmodic
conftriction by their (harp points.
I, however, have never denied but that the kidnies may, fometimes, and,
'if you pleafe, often, be vitiated, and the ureters diftended, in that other
manner alfo. And I even fay, that if this has preceded, and the calculi then
(<■) Eph. n. c. cent. 8. obf. 15.
(d) Ibid. obf. 22.
(/) Cunt. I. obf. 58.
if) Cent. 9. obf. 2.
fa) Dec. 3. a. 7 & 8. obf. 27.
Vol. II.
[b) Specim. Experim. circa Generat. f. 2. c.
3. hift. 3.
(/) Diflert. de Valvul. in ureterib. §. 5 & 7.
(A) Diflert. deVafr. umbilical. §. 6.
(/) Epift. 4. a. 19.
t t at
506 Book III. Of Difeafes of the Belly.
at length falling into the bladder, and obstructing, or pricking it, the fe-
cond fhall of'courfe fucceed ; the diforder of the kidnies, and of the ureters,
Will be ib much the more increas'd by the regurgitation of the purulent urine,
in proportion as they have been more affected or weaken'd by the firft mode
of difeafe.
You plainly fee then, what a prudent lithotomifl ought to attend to, when
lent for to extract a calculus, from a patient who has iuffer'd many and grie-
vous diforders therefrom ; and how cautious he ought to be of undertaking
the operation : or if he is, at any time, compell'd, by the impatience of the
patient, to perform the extraction, at leaft what he ought to predict, in re-
gard to the danger and diforder which may remain even after the fuccefsful
extraction of the ftone.
" If ulcers of the kidnies," fays Aretseus (/«), " are brought on by cal-
" culi, incurable diforders arife therefrom : and a fpeedy colliquation, and
*' death, come on :" in which opinion he was preceded by Hippocrates (n),
who even pronounc'd in general, of fuppu rated kidnies, " that this dileafe
" was very violent ; and that many were, thereby, brought to a tabes rena-
" lis :" and if the patient is much advanc'd in age, not only (o) " that dif-
" orders of the kidnies, and bladder, are with difficulty cur'd," but alfo (p\
" that he had not feen diforders of the kidnies cur'd when the patient was
*' above fifty years of age."
I am not ignorant, indeed, how much is to be attributed to fortune in thefe
things, as well as in mod others : for I remember that the cure of a Venetian
nobleman, of more than fixty years of age, which had been defpair'd of by
Alghifi, for more than one reafon, and thefe not flight neither; was foon af-
ter undertaken, and very happily perform'd, by that friar Jaques Beaulieu, as
I formerly declar'd at large, by letter, to the celebrated Morand, who re-
quefted it of me : and I have read of another cure in the Sepulchretum (j),
which was more hazardous in the beginning, but had not an unfuccefsful
event.
And in the Sepulchretum (r) is alfo extant the hiftory of a princefs, who ;
having been before tortur'd with very violent pains of the loins, together
with a difcharge of blood, and pus, in the urine ; and being afterwards freed
from them, and at length carried off by another difeafe; had a fmall calculus
in thekidney " around which a beautiful cicatrix, found, and clean, and of the
" length of half an inch," had been form'd.
And indeed, read over the obfervation of Brunnerus, which I juft now
quoted, on the prince. You will not only perceive, that the fame palliative
method of cure, which I faid above (s) Valfalva had been wont to recur to,
had been of fo much advantage to this princely patient, that Brunnerus has
juftly faid, which I wifh lithotomifts would remember in hazardous cafes,
" therefore lithotomy will not always be abfolutely necelTary in the calculus
" of the bladder-," but moreover, " what almoft exceeds belief, that the
" diflecter had found cicatrices in the bladder," of the ulcers which the cal-
('■0 DeSign. & Cauf. Diuturn. Morb. 1. 2. (/) DeMorb. Popular. 1. 6. (eft. 7.
c. 3. in fin. (q) Seft. fuper 23. obf. 4. §. 13.
('•/) De Intern. Affcft. n. 16. (') Sett. 22. obf. 26. §. 8.
(0) Sett. 6. aph. 6. (/) N. 16.
4 cuius,
Letter XLII. Article 25, 26. 507
cuius, and a contrary method of treatment, had before prod ut'd : although
the patient was more than fixty years ot" age.
But, without doubt, it is a very different thing to confider what rarely hap-
pens, and what happens the mod frequently : and, to return to the cales of the
girls we were fpeaking of, it is one thing to be lent for in time, and another
when i!u d'ieafe is very far advane'd : this will appear from an observation that
was written to me, in the fame letter, which I mention'd above (/) •, that is by
the very experiene'd phyfician Laurence Mariani.
25. A young country-girl, having had a bone bodkin, which flie us'd for her
hair, drawn into the bladder, in the fame manner as in thofe already fpoken
of; although it created pains, and many uncafine fifes, they did not, neverthe-
lefs, extort a confeffion of the fact, before that a calculus, having form'd it-
felf around the needle, fhe was affected with intolerable tortures.
Then, at length, the fituation thereof being examin'd, the point of the
needle was found to be prominent within the cavity of the vagina •, the ure-
thra being perforated near to the lower part of that cavity.
Itfeem'd to Mariani, that, if the urethra were cut into a little, in a longi-
tudinal direction, this point might be drawn into the urethra •, and, by this
means, the needle and the calculus being plac'd in a direct fituation, it might
be tried whether by fcaling away this calculus, which was, perhaps, of a fra-
gile nature, gradually and dexteroufly, it were poffible to reduce it to filch a
itatc of thinnefs, as to fuffer it to be taken away with the needle.
But as others were of a contrary opinion, it happen'd that nothing at all
was attempted ; but that the girl was deferted, and given up to her miferable
lot. In procefs of time the calculus, and the pain alfo, were increas'd ; and
the whole orifice of the bladder being now almoft ftop'd up, but a fmall quan-
tity of urine, and that very ill-fmelling, was difcharg'd. And a fever alfo
coming, on an end was, at length, put to her miferable life.
- The belly being open'd, pus was feen in the pelvis thereof, and was fup-
pos'd to have been pour'd out from the kidnies, which were fuppurated. In
the bladder, which was corrupted with a fphacelus, was a calculus of the fi-
gure of a pear •, for the more it defcended from the head, and the upper part
of the needle, the more was it extenuated.
When it was taken away from the bladder, to which it adher'd in fome part,
it left fcales agglutinated to that part : and yet when put in the fcale, toge-
ther with the needle, was then equal to eighteen drachms ; but afterwards,
when this account was fent to me, it weigh'd no more than fourteen.
26. The perfon who, as I have laid above («), had fuccefsfully extracted
the needle from another girl, before a (tone had been form'd upon it, did
not defpair but this alfo might be taken out ; even when the calculus was
begun, and increas'd to a confiderable fize •, if, the point of the needle be-
ing redue'd into the urethra, and held fart with a forceps, he endeavour'd,
previoufly, to extenuate the calculus, if it were poffible, before he drew it
out ; in imitation of Benivenius (*), who diminifh'd it in the urethra of a vir-
gin, in fome meafure, previoufly to its extraction ; or if this did not fucceed
(t) N. 22. (a) De Abditis Morbor. Caufis c. 80.
(«) N. eod. 22.
T t t 2 accord-
508 Book III. Of Difcafes of the Belly.
according to his wifh, then to imitate Molinetti (j), who had taken care to
have it extracted by force, at all events •, and it is probable that fomething
might even then have been offer vice.
But after the calculus had been fo much augmented in its fize, and with this
every diforder had increas'd, who is there that could hope for any advantage ?
And if the calculus had been fo much thinner, and the pafiage, through
which the cavity of the urethra, communicated with the cavity of the vagina,
had been fo much larger, as they muft both of them have been in a cafe of
this kind, which, being fent from Italy, you read of in the hiftory of the
Royal Academy of Sciences at Paris (2), perhaps this alfo would have fallen
out into the vagina, in the fame manner as that did.
But I mould believe, even in that cafe alfo, that the pafiage had been
from the upper part of the urethra, rather than from the bladder, into the
vagina; fince we read that an afflux of urine, through the vagina, did not
fucceed, but only an incontinence of urine.
For whether the needle is not wholly fnatch'd away from the ringers, inter
the bladder, in many perfons, as I conjectur'd above (a) ; or, if you pleafe,
whether, after it is wholly carried into the bladder, it is again pufli'd back into
the urethra, by the contraction of the bladder ; although the former of thefe
fuppofitions feems to me the more probable, fince the point that was held in
the fingers, and not the head, or, at lead, in the examples of Molinetti, and
Mariani, and in as many that I mall immediately produce, was certainly
turn'd towards the urethra; nothing can more eafily happen, than that, the
head being pufh'd forwards, by the pofterior part of the bladder, in confe-
quence of the annex'd vagina, then libidinoufly turgid, being, in like manner,
fore'd forwards, the point of the crooked needle is driven backwards-, and
by this means fixes itfelf into the pofterior part of the urethra, efpecially if
it be very fharp : and at length, being driven by the frequent contractions of.
the bladder, perforates that part.
And as this happen'd in a young country-girl, who applied to our fur-
geons at the time of my writing this letter, fo it would alfo have happen'd in
a young virgin of fourteen years of age, the cafe of whom was related to mo
by a furgeon, whofe preceptor in anatomy I had been ; not long after the
death of the other, whofe difiection I have defcrib'd to you {b).
This girl was in a fitting pofture when fhe did the fame thing as the other,
and had thruft the head of the bodkin, which was almoft as thick as the ure-
thra itfelf, very high into this meatus ; and being terrified by the fudden ap-
pearance of her mother, at once let go the bodkin, and found it drawn up
very high, at the fame time.
Almoft four days fhe bore the pains and uneafineffes in filence ; on the
fifth fhe told her mother the affair, and her mother told it to the furgeon, of
•whom Ihaye fpoken. Who fuppofing, from the feat of the pricking, of
which the patient chiefly complain'd, that the lower part of the needle ftuck.
hVd about the middle of the urethra ; and fearing left, if any inftrument were
introdue'd into the urethra, to extract this inherent body, it mould be entirely .
(y) C. cit. fupra ad n. 21. (a) N. 21.
(z) A. 1735. obf. anat. 10., (£) N. 20..
2 puflrd
Letter XLII. Article 27. 509
pufh'd on into the bladder-, lie with the confent, and even at the requeft,
both of the mother and daughter, introdue'd firil one finder, and then an-
other, into the vagina, and by this means fo far mov'd the needle downwards,
with no lefs induftry than fuccefs, that the point began to appear at the orifice
of the urethra, and could be laid hold of with the forceps.
Thus, with the lofs of two drops of blood only, and without any inconve-
nience remaining behind,- the needle, which he brought to me, was taken
out. This needle, or bodkin, was, or, at lead, fcem'd to be, of tin, and
was of that kind which women life for their hair, being four inches long, and
having a very fharp point : and die furgeon had obferv'd that a little tarta-
rous matter had already begun to adhere to ir, in feveral places •, which mat-
ter was, arterwards, very improperly rub'd off.
27. I would not have you be chagrin'd tofind that what has been aflTerted by
fome perfons, fcems to be confirm'd by the number of examples I have add-
ed i I mean that the women, to whom thefe things happen, " are the
" grcateft part of them Italians." I could wifh all our country-women knew
how many of their fex have been untimely carried off, by the moft excruciat-
ing tortures from this caufe.
But how can country-girls, or girls of the lower clafs, and fuch as even
their tender years render unexperienc-'d, be acquainted with thefe things ?
Yet fuch inftances ought not to be pafs'd over in filence, that phyficians, be-
ing admonifh'd by the frequency of them, may, if any girl begin to com-
plain of a difficulty of making water, inquire very narrowly into every cir-
cumftance ; and, by a cautious dexterity, force out the truth, while it is as-
yet pofiible to adminifter relief. .
However, neither thefe inftances are common to all parts of Italy, (or, at
lead, not to fome of them, where I have been for a confiderable time) nor
are all foreign countries free therefrom; which examples it is by no means
neceffary for me to take notice of here, with an odious diligence : fome of
them you will learn, if you afk me how, from reading Vallifneri (c), others
from Platner (d) ; and, finally, fome you wHl meet with in the reading of
other authors.
Nor do I doubt but more examples would be extant, if as many bodies were
difiected in every other place as there are in Italy •, or if fhame did not oblige
moft women to conceal the true caufe of their difeafe. For others -, as even
among the women of this region a country-girl was about to do(e) -, and as
fome, according to Alghifi (f), and Vallifneri (g)t have done ; conceal the
whole affair with the moft obftinate filence: it therefore happens, that the
needle, of which no body has any fufpicion, is buried together with them.
And fome girls pretend to have fwallow'd it ; in order that phyficians, not-
withstanding they find it either in the living, or the dead body, may be.
deceiv'd by fuch an affertion.
There was a time when fuch deceptions took place even in Italy ; as by
that Venetian virgin fpoken of by Alexander Benedictus^,), about the la:-
(c) Obf. fupra ad n. 19. cit. (f) Litotom.c. 3.
(d) Dif. dcCalc. ad Vefic. adhjer. \. 10. \g) Adnot. ad cit. obf.
not. Sc p. \/b) Hilt. Co.-p. Hum. 1. 2. c. 9.
<f).N. 20.
ter
510 Book III. Of Difcafes of the Belly.
tcr end of the fifteenth century, who had a large calculus form'd upon a very
long bodkin, fuchas women ule in their hair : for notwithstanding this author
has rejected the opinions of thofe (*'), who fuppos'd the needle to have pafs'd
through the veins, from the ftomach to the liver, from thence to the heart,
and from this vifcus to the kidnies, and fo on to the bladder ; yet he himL-lf
thought, " that by its point, it had, gradually, and in a long courfe of time,
" penetrated through the inteftines, and made a pafiage for itfelf to the blad-
" der :" although he is much to be commended for having difcarded the opinion,
which, to my great aftonifhment, was embrae'd by others, even a longtime
after, and is not eafily to be imitated in propofing another, which had a much
greater number of followers.
Nor is the; queftion, here, of any (lender needle, but of thick ones ; and
very often of thofe which have a large head at one extremity, and, at the
other, not a very (harp point •, and always (I mean in thofe fhame-fae'd vir-
gins, who fay that they had been fwallow'd by them) purpofely, as it were,
going to the bladder ; and not attended with thofe previous, and conco-
mitant fymptoms, and pains, which a circumftance and pafiage of this kind
requir'd.
Wherefore this kind of credulity is now more rare •, or, at lead, among
the more learn'd Italians ; the retention of which, in fome other countries, I
fee pretty clear marks of, even in fome excellent books. It remain'd to take
notice not only of the needle, but of the cafe wherein they are kept, having
pafs'd the fame way ; fince that excellent man, Benevoli, fays, that he had- ex-
tracted one from the bladder of a Tufcan girl (k).
Here again, you will perhaps be difpleas'd, that a vice almo(l incredible
fliould be imputed to an Italian girl. But read, I beg of you, the annotations
that are made to article one thoufand three hundred and fifty-nine (/) of
Platner's Injlitutiones Chirurgia, and you will fee whether fhe was the firfl that
had attempted this thing.
Yet if they had made ufe of that way of Alexander Benedict, to explain the
pafiage of any needle, not into the female bladder; into which a very (hort,
and quick opening, lies from without •, but into the male bladder, the pafiage
into which is much longer, and more winding ; I fhould more readily, as I
have faid in a former work (m), and particularly in fome cafes, fall in with
their opinion.
And I wifh it was in my power to fall in with their opinion in this cafe that
I fhall immediately defcribe to you : I fhould then have complain'd lefs at that
time, and even now, that, in proportion as a thing is more certain, it is fo
much the more difficult to be conceiv'd of.
28. A country-man, of forty years of age, had labour'd, for a long time,
under a very great difficulty of making water : nor on this account only, did
he come into this hofpital, a month before he died, but on account of an ul-
ceration of the fcrotum, and a fever likewife. To his fever was firft added a
diarrhasa, and after that a coftivenefs : and a greater wafting of flefh came on
every day ; which being carried to its greateft pofiible extent, and his face
(;) L. 5. c. 13. (/) Not. b.
\k) OU'erv. 42. (m) Adverf. 3. animad. 36.
being
Letter XLII. Article 28. 511
being become cachectic, he was, at length, taken off by the oIJ pains in his
bladder.
When he was very near death, he feem'd to be defirous of what few men
of his condition in life are-, I mean that the caufe of this very long, and trou-
blefome dyfuria, lhould be inquii'd into by diffection. He therefore call'd
the furgeon to him, and told him that, two years before, he had introdue'd a
hair-bodkin made of bra Is, into the urethra-, but whether it had fallen out,
or It ill remain'd there, he fcarcely then knew, and was ignorant even to the
prefent moment.
But in what manner, and for what purpofe, he had introdue'd it, he did
not lay, nor did the furgeon inquire ; as the man was now dying, and had
I ir'd even thus far, with fome degree of fhame. The furgeon having
made this relation to me, and I being at that time accidentally engag'd in
demonihating fome things, in the hofpital ; both natural and preternatural-,
I immediately order'd the carcale to be brought, in order to add this inquiry,
whii h I fuppos'd to be fhort, to the others.
And as 1 fuppos'd that the needle had ftuck at the flexure of the urethra ;
or if it had acci. fallen out, that it muft, at lead, have left fome great
marks of injury I thought proper that the urethra mould firft of all be
laid open, lor din ally, to that part.
The fcrotum therefore, which was Hill ulcerated from the dripping of the
urine, as I iuppofe, being cut into, the teftes feem'd to be larger than they
naturally are, and quite tumid •, but it eafily appear'd that this was owing to
the coats being become very thick and white : and not to their proper fub-
ftance being dillended. For this, notwithftanding the tunica vaginalis ad-
her'd, in leveral places, to the tunica albuginea, was pretty found -, except
where it is connected with the inferior globe of the epididymis : for thefe
parts were purulent, and blackifh in their colour.
The urethra being then open'd •, from its external orifice, through the
whole inferior furface of the penis, and the perinsum; I found the internal
furface of this meatus to be neither ulcerated, nor cicatriz'd, nor red : and I
even found it to be every where whitifh and fmooth -, but become pretty much
thicken'd.
Thus when I perceiv'd that I muft carry on my refearches ftill farther, I
immediately order'd all the other parts, that belong to the urinary fecretion
and excretion, to be taken out. The bladder was without urine, and con-
tracted into itfelf, but of an irregular figure. For at the upper and right
fide, it grew out into a" kind of fmall bag, of a fquare figure, that was already
blackifh in its colour.
What this fac was, and what it contain'd, appear'd plainly to all ; after firft
cutting into the upper part of the urethra, which ftill remain'd to be exa-
min'd on the anterior furface, and after that the bladder itfelf. And in this
part of the urethra, quite to the whole feminal caruncle ; which was ftrigofe
and fhrivel'd, yet furnifh'd with a finus according to its natural ftate ; we
found no more traces of diforder, than in the other part of the urethra, that
we had before difTected.
But immediately above the caruncle, the whole internal furface, not only
of the proftate gland, but of the bladder alfo, was found to be ulcerated -,
and
5 1 2 Book III. Of the Difcafes of the Belly.
and cover' J over with a kind of whiiifh efehar, as it were, or cruft. And thr
coats of the bladder, as was obferv'd by cutting into them, had become
thick •, being partly livid, and black, partly white, and almoft fcirrhous. Nor
did the fac, of which I have fpoken, put on any different appearance: for it
not only communicated with the bladder, by an orifice of equal extent with
itfelf, but was even made by a production of all the coats of this refervoir.
Within this bag was a calculus, of the bignefs of a middle-fiz'd, or ra-
ther of a fmall walnut •, being ibmewhat like this nut even in its fio-ure,
and fmear'd over with a humour that refembled the white of an egg,
but not in great quantity : from the fide of this calculus, pretty near to one
extremity, came out that .needle, and was prominent to the extent of two
fingers breadths ; the remaining part of it, which belong'd to the head, be-
ing buried deeply, or, at lead, very firmly, within the calculus ; fo that it
might feem to be equal to, or even perhaps to exceed, another finger's
breadth.
But the other part, which belong'd to the point, that was very fharp, and was
itfelf perfectly flrait ■, in confequence of its being a part of one of thofe needles,
which is pretty ftrong, and not thin •, only pafs'd obliquely downwards be-
yond the orifice of the fac, fo as to fix its point into the lower, and left fide,
of the contracted bladder •, from whence it was drawn out with great eafe.
What weight the calculus was then of, I did not inquire : but, on inquir-
ing, feven years after it had been found, it exceeded, together with the
needle, two drachms and as many fcruples, by ten grains ; or, if you pleafe,
according, to the ufe of medical weights here, by half a fcruple. In the place
where I kept it, was a yellowifh powder depofited ; for it is of a furface not
fmooth, and, for the moft part, inclining to that colour.
•In the bladder, however, the orifices of the ureters were much larger than
they generally are : the ureters were very wide, and diftended with pus to
fuch a degree, as, in fome places, to equal the thicknefs of a man's thumb.
The kidnies alfo were turgid, and much enlarg'd beyond their natural fize :
being externally pallid; but internally femiputrid, and abounding with a ci-
neritious pus. To examine the other parts of this body I thought unnecef-
fary ; and indeed had not leilure to do it.
29. This rare, and if you weigh all the circumftances properly, this perhaps
.Angular obfervation, I made on the twenty-ninth of December, in the year 1 742,
before. a very crouded circle of ftudents and doctors •, and thefummary there-
ofl fent, in a letter, to the celebrated Morand, in July of the following
year : this eminent man wrote back to me, that he had communicated it to
the Royal Academy of Surgeons, and nothing more on this fubjectthat ever
came to my hands.
But my reafon for fending him the account, was that, if any thing of the
like kind had happen'd at Paris (a city very famous for the number of its in-
habitants, and befides other fciences, particularly for that of lithotomy) I
might be inform'd thereof ; and might not be ignorant in what manner they
fuppos'd this to have happen'd. When I fpeak thus I mean to fpeak of a
needle of the fame length, firmnefs and ftraitnefs, as ours is •, for that a fhort-
er, or flexile needle fhould have reach'd to the bladder, through the pafTage
of the male urethra, would not be equally furprizing.
I had
Letter XLIL Article 29, 51?
I had read, indeed, in Parey (w)> °f 1 calculus taken out of the male blad-
der, " of the thicknefs of a walnut, in the middle of which a needle, pi
" feebly like thofe commonly us'd by fempftrefles, was found to be tix'd."
But if it was buried within the calculus, it was of COUrfe Ihorter than ours:
if it was prominent from the calculus, we are, neverthelefs, ignorant what
length it was of.
And in what form it appear'd •, whether it was a little bent, or (Irak •, but
in particular, whether it had come in by way of the urethra, or not •, we are
quite ignorant. For there might be different ways whereby a needle, ripe*
cially one that had no head, might come into the bladder.
Thus that very learned man Mead fuppos'd a limilar needle •, which Che-
felden (o) gives a figure of, if I rightly recoiled!:, in the thirtieth plate ; and
which, having a calculus form'd around it, had been taken out from the blad-
der of a boy, by incifion ; to have enter'd in by the perinxum : and Vallif-
neri (p) fufpected that a fmall branch of a certain plant, .which he had found
within a calculus of the bladder of a boar, had com? thither through a wound
that had been inflicted on the belly of this animal, by fome hard and fharp
branch of the thick forelt, through which he had run : but whether another
" kind of woody little body," which is laid to have been found in the blad-
der of a domeftic fow (q), might have come thither in the lame way, you
yourfelf will determine.
Moreover, there might be another paffage for a needle ; I mean that which
is propos'd by Benedict, from the interlines into the bladder ; for although I
faid above (V), that this was not readily to be admitted, yet I do not think it
is always to be rejected •, efpecially when what I have there objected can have
no place.
I will endeavour to illuftrate what I mean, by an example which I do not <Le~/~0
remember to have been refer'd to, by thole who have taken notice of others
ot this kind. You have it among the Refponjiones Medicinales of Claudinus (j).
A boy had fwallow'd a needle, which he himfelf, after fome years, took out
of his urethra, where it was driven by a very great effort in making water $
having a thin ftone form'd upon it.
By what paffage this needle had come into the bladder, or at leaft into the
urethra, was demonftrated by long, rodnd, and living worms ; fome of which
he difcharg'd, in his urine, in the firfl: years after having fwallow'd the nee-
dle : and after pains of the urinary parts, and even after the needle was
taken away, another living worm of a confiderable length was difcharg'd, and
not without foetid matter, which was of a black colour.
And as you fee that this example may be added to thofe which I have
taken notice of above (0, when fpeaking of worms difcharg'd by the ure-
thra ; fo you alio perceive, that, although the needle, in the cafe of this boy,
exceeded two inches in length, and was not without a head, yet it cannot be
transfer'd to thofe girls, who fay that their hair-bodkins have come down from
their mouths into their bladders ; if it be certain that they have fuffer'd none
(n) Oper. 1. 24. c. 19. (q) Eph. n. c. cent. 7. obf. 7. cum SchoKo.
(9) The Anat. of the Human Body. (r) N. z-j.
(p) Opere torn. 1. p. 6. nella lettera al Gi- (s) Refp. 40.
Jorgi. (/) N. 6.
Vol. II, U u u of
514 Book III. Of Difeafcs of the Belly.
of thofe fymptoms, which demonftrate that a paflage, from tire inteftines to
the bladder, was laid open : yet as this is not certain in regard to the man
ipoken of by Parey, nothing forbids us to fufpect that the needle might have
made the fame kind of paflage for itillf, formerly, in him.
But there are others, in whom there is no room for thefe fufpicions, as
they, like ours, confefs the contrary, one, that he had thruft into the bladder,
thro' the urethra, an ear of barley •, the other, if I underftand rightly, the
thin extremity of a fmall iron fpatula or fpoon. And I confefs it, becaufe I
have read of the latter in Dionis («), and of the other in Platner (x). But
of what length the extremity of that fpoon wasr and whether it was at all in-
flected, I do not yet know •, how flexible the ear of barley is, there is nobody
who is ignorant.
Befides both of them, as it feems to me, or at lead one of them, has con-
fefs'd that what he had begun to thruft in, he had fore'd on farther, and
even quite into the bladder. But our man was fo far from pufhing forwards
the needle, which he had introdue'd into the beginning of the urethra, that
he was, as I have faid(j), quite ignorant whether it had fallen out, or re-
main'd.
Let us fuppofe, however, that he did pufh it forwards ; yet when he had
brought it on to that flexure, which is in the perineum, how, I befeech you,
could he, at length, get over that obftrudtion ? and how could a needle of
fuch a length, and fo ftrait, be turn'd upwards ? Why did it not flick there ?
Why with fo fharp a point, if this went foremoil, did it not fix itfelf there ?
Or if, as is moft probable, the point did not precede, why did it not injure
that part, while the needle was turn'd ? For there was, as I have faid, no ci-
catrix there.
Thefe therefore, are things which I confefs I cannot yet attain to the com-
pleat knowledge of: and all very fkilful men have confefs'd the fame; in
particular Cocchi and Benevoli, who each of them vifited me with very great
politenefs, as they pafs'd this way •, and faw, and confider'd, the fubject very
attentively.
It is true, that, in regard to very fmall, and for that reafon flexible,,
needles, I Ihould not be in any doubt •, much lefs in refpect to very flender
wax candles : of which if you read the cafe, that in all appearance is the
fame, although it is repeated, in other words, twenty-five years after (z) ;
you will be lefs furpriz'd, even if you admit only of fame parr, that the fe-
male bladder mould fuddenly draw a needle into its cavity •, when you alfo
find that the male bladder " had fuddenly drawn in a candle."
30. As to the kidnies and the ureters, being both of them enlarg'd, in our
ruftic ; and both of them being fill'd with pus •, thefe circumftances doubtlefs
agree with thofe things which are laid down and explain'd above (a). And
from the fame caufe, that is from the urine being very frequently retain'd,
on account of the very violent dyfuria -t and for that reafon forcing fome part
(«) Cours d'Operat. de Chirurg. 3. De- fzj Eph. n. c. cent. 1 &* 2. obf. 152. 8e.
Bionftr. aft. torn. 4. obf. 24.
(x) Difp. fi»pra ad n. 27. cit. §. 11. («) N. 22, 23.
(y) N. 28.
«f
Letter XLII. Article 30. 515
X)f the bladder outwards where it was weakeft i I think that the facculus, in
which the ftone lay, is to be accounted for.
And that this was my opinion, even at the time when I firft wrote, in the
Adverlaria (b), what I had obferv'd of thefe facculi, you very well know,
from what is there laid. But that this was afterwards confirm'd by others, I
am not ignorant •, as they produe'd the examples of gravid women, whofe
bladder had been, in fome meafure, relax'd, from a violent ifchuria, into fac-
culi of this kind ; or hernia; •, by which name I had alfo calPd them : yet I
do not very well fee, why, among thefe examples, is reckon'd that which is
extant in Ruyfch •, in his eighth Thefaurus, number one hundred and two ;
unlefs, perhaps, that, which is there defcrib'd, is not intended, but the other
which is repeated in the lame place, on occafion of the foremention'd in-
ilance -, that is to lay the firft obfervation of the Centuria of Ruyfch : with
which obfervation you will compare another given us, in the a£ts of the
Caefarean Academy (c) ; and you will eafily underftand, what the tumour
was, in a very noble matron, which hung down from the genitals •, upon the
incifion of which a large calculus was difcharg'd, together with the urine :
and an incontinence of this fluid, or rather a ftillicidium, or continual drip-
ping, fucceeded, in confequence of the wound that had been made, not being
heal'd.
Yet thefe two obfervations, and fome others, that may feem to be of the
fame kind, of Rembertus Dodonaeus (ci), mow that the fac was not form'd
more by the impulfe of the urine, than by the weight of the calculi, or at
leaft not more increas'd ; and that in the lower part of the bladder : where
Riolanus had alfo feen it formerly (1?), and from calculi indeed (/), but at
the fides of the bladder, and fometimes only.
Yet now I fee, that they are fuppos'd at the fides, and particularly the
left, in mod perfons ; and that by fome, at leaft, as if the appearance were
natural. What I have feen of the figure of the human bladder, in a natural
Hate, I have already declar'd in a former work (g). Whether it has thefe
fiBufies, or appendages, as they call them, befides, I fhall not willingly difpute
here.
It would be fufficient for me, if all the circumftances, which I advanced
in regard to this figure, before Weitbrecht, were related in fuch a manner,
by fome perfons, that I might not feem, with divine permiflion, to have
propos'd them after him : although nobody can have read that difiertation of
his, without being put in mind of the time, in which each of us publifh'd
our remarks •, I mean by that very annotation, which the no lefs juft, than
learned, imperial academy at Peterfburgh (h) has, of its own accord, added
to that difiertation.
Nor have there been fome wanting, who have confounded thofe finufies
feen by Riolanus, and others, promifcuoufly with thofe, which I had obferv'd,
Irom the urine being too long retain'd in the bladder, and not from calculi,
of which firft kind thofe two appendages, probably, might be, that Berger
ih) HI. Animad. 36. (/) Encheirid. anat. 1. 2. c. 30.
(t) Tom. 4. obf. 95. in fine. (g) Epift. anat. 1. n. 61.
(</) Medic, obf. c. 4.5, \.h) Comment, torn. 5.
'Uithropogr. 1. 2. C- id.
U u u 2 (;') found
51 6 Book III. Of the Difcafes of the Belly.
(i) found in the bladder, like facculi •, for they were full of urine, and were
in an old man who had died of a fuppreffion of urine : and that they were of
this kind, we fhould more certainly know, if he had obferv'd the places from
which they were prominent.
But there had been perfons before, who explain'd the origin of facculi
of the bladder in a different manner (k) ; fome accounting for them even
from a primeval conformation ; and others from a calculus, which, growing
by degrees, betwixt the coats of the bladder, forms to itfelf a fac, hanging
from the bladder by the feparation of thefe coats : and the internal coat being
at length ruptur'd, or corroded, the calculus communicates with the cavity
of the bladder ; which explanation of the communication, a certain perfon
not long ago made his own ; although in the whole of that difputation, in
which he has canvafs'd the various modes, wherein calculi adhere to the blad-
der, he has no where exprefly taken notice of thofe facculi that are prominent
on the outfide of the bladder.
However, I am not altogether repugnant to thefe two origins of facculi.
bemg fuppos'd, in fome certain cafes ; though that they fliouid be fuppos'd
in all we cannot allow : as not only other observations of ours, which have
been defcrib'd in other places, but as that alfo, in particular, which was juft
now defcrib'd (m), are openly repugnant thereto.
For you fee from the Adverfaria (n), when, in a great drinker, fome fac-
culi were already form'd, and others began to be form'd, that the begin-
nings of them had appear'd only in thole places, where, by reafon of the
fpaces, which the mufcular fibres of the bladder leave betwixt each other,
the coats could be urg'd outwards: and who can imagine, that the facculus
of the country-man had exifted from the original formation, rather than that
it had fucceeded to the very frequent retention of urine, from the needle, or-
calculus.
Nor indeed could a calculus, which was form'd upon a needle, that was
thrufl into the cavity of the bladder, have been form'd betwixt coat and coat;
nor confequently, could it have burft through the internal coat, to open a
pa Mage for itfelf into the bladder. And there has not even been one, out of all
thofe in whom I have found thefe facs, wherein that coat was ruptur'd : whereas
in all, as well as the other coats, it was relax'd, and had expanded itfelf, in
order to form the facculus ; as you will learn from reading over again the dif-
lections of the countryman, and of a certain old man of whom I wrote to
you formerly (o).
Nor did I fee calculi within thofe facculi, if you except the country-man ;
nor yet did I underftand that there had been any before : nor did it happen
to me to meet with thefe facculi, at the very mouths of the ureters, or be-
neath ; but above them and even much above; as you will clearly perceive
from thofe obfervations of mine, which I have refer'd to.
31. Thefe facculi, then, are different from thofe which are form'd by
{tones flicking at the narrow orifices of the ureters, and increafing there; as
(/) Hill, de l'Acad. R. des Sc. a. 1704. obf. (/) Ibid, in Schol.ad §. 7. obf. 8.
anat. 22. (m) N. 28.
(/:) Seft. hac Sepulchr, 25. in Schol. ad (n) Animr.d. cit.
obf. 3. (0) Epirt. 21. n. 15.
Fetrus
Letter XLII. Article 31. 517
Petrus Francus (p) formerly knew, although he has neither been quoted by
Riolanus (q), nor by Willis (r), nor by any of the great number of other
authors, that I know of, who have been of the fame opinion, even to this
time, Platner only excepted (j); who has alio given a copy of that fmall pare
of his very rare book, which relates to this fubjedt;
But as to Platncr's having follow'd Littre (7), and Abraham Vater («), fo
far as to add, that, unleis the calculi fall out from thence, " they Teem to
*' make a new paflage tor themfelves •, while, the bladder being now and
" then very ttrongly contracted, they are propell'd, within the coats of it,
" towards the cervix: and that this is the reafon why they are often found
U in places that are very remote from the mouths of the ureters ," I mould
readily fall in with his afiertion, when paflages lie open from the loweit part
of the ureter (as were ftcn by Littre) to thofe places ; which, when once
open'd by calculi, it is molt probable mult be kept open afterwards, by the
urine that is continually following them : and I do not .doubt, but that the
places very remote from the mouths of the ureters, are always to be under-
ftood as being downwards only ; even from confulering the words that I juft
now copied ; to which part not only the weight of the urine, defcending
through the \ireters, urges, but the contraction of the bladder forces, the
calculi.
In what manner, then, mall we explain the many other obfervations, of
calculi of the bladder, included in a membrane, which Platner himfelf takes
notice of in the fame place? Were all thefe at the mouths of the ureters, or
below them ? And were they thus alfo, in the other obfervations be fides
thefe, that may be read in the Sepulchretum (x) ? In one of Tulpius (y) in.
particular (for although there are many there from Tulpius, Platner did not
refer to them all,-,but only to fome one of them) in which nine and thirty
calculi are defcrib'd in the bladder; " every one of which lay wrap'd up in
" its proper receptacle, and indeed fo clofely, that in the beginning, the
" furgeon was led tofuppofe no calculi to be contain'd therein ?"
To this obfervation join another of Holtzappellius (z)r which fpeaks of
two and thirty calculi, " all included in their proper coats, and contiguous
" to each other •, fo that thefe calculi, each in its little cavity, fill'd up the
" whole concavity of the bladder ; juft as bees, in their fmall caverns, fill
" up the honey-comb •, only a very fmall paflage for the urine remaining."
Were all thefe, then, wrap'd up, in this manner, below the orifices of
the ureters ? And indeed it has fometimes come into my mind, as I have;
found {a) calculi within the biliary glands of the gall-bladder, to confider
from thence, whether it is pofllble, that, through the orifices of the glands
of the bladder, which, as I have fometimes found them open in the ureters,.
fo alfo nothing forbids us fuppofing to be fometimes open in the bladder,
which is but a continuation, as it were, of thefe c%nals ; whether, I fay, it is
(p) Traite des Hernies c. 31. (u) Diflert. quaobf. rar. Calcul. &c. §. 4.
(7) Anthropogr. 1. 2.c. 28. (x) Se&. hac. 25. obf. 8. §.7. 13. I+.-&
ft) Dill", de Urin. c. 5. feft. 24. obf. 10. §. 1.
(s) Difp. fupra ad n. 27. cit. §. 13. & not.. (_y) Seft. 23. obf. 7. §. «.
Ibid. n. (z) Ibid. obf. 4. §. 2.
(t) Mem. de l'Acad. R. des Sc. a. 1702. («) I'.pift. 37. n. 23.
gofitfck
518 Book III. Of Difeafes of the Belly.
poffible that through the orifices of thefe glands, very fmall pieces of fand
may creep into the cavities of the glands, and there increafe into calculi,
which will be inherent in their alveoli.
But till 1 happen to light on a bladder, which has a calculus fhut up, be-
twixt the coats, in fuch a place, as it could not pofiibly have come to, from
the ureters •, and have an opportunity of examining it very attentively; I
ihall choofe rather to withold my affent from this hypothefis of mine; and as
I have learned froin my obfervations, refer'd to above (£), that the orifices of
the facculi are often much lefs than the facculi themfelves, I fhall alfo give
ibme room for another conjecture ; as, for inftance, if a very fmall calculus
having enter'd in, the orifice mould from any caufe whatever, be more
ftreighten'd, and almoft, or altogether, fhut up.
But there are many facculi, fometimes, in one bladder; and amongft thefe
even fmall ones, which not only occupies the inferior, and middle parts, of
the bladder, but the upper parts alfo : and this you will understand from
thofe obfervations of mine ; and ltill more clearly from two figures, which,
as I have faid in another place, the celebrated Heifter has added to his Latin
chirurgical inftitutions (c) ; and that with fo much the more propriety, as it
was a circumftance greatly to be wifh'd, that they might not be altogether
omitted, by any one of thofe who have written of Lithotomy, after frequent
mention having been made of thefe facculi.
32. For it is of great importance to the lithotomift, to have them always
in his eye, as by thefe he may very eafily be deceiv'd. And if Riolanus (d)
has taught us, that the calculi, which have their niduffes in thofe lower
finuffes of the bladder, *' are not met with on the introduction of the cathe-
*' ter-, and if the cafe defcrib'd by the celebrated Jo. Chriftoph. Mayo (e)y
fhows the difficulty of taking out a calculus from thofe finuffes-, it will na-
turally come into his mind, when confidering a great number of facculi, as
exifting in different parts of the bladder, how many cafes may happen to
him, in which ; to omit the difficulties of the cure ; he may be deceiv'd,
even in the very article of fearching for the ftone.
And indeed from -thence, as I fee in the celebrated Schreiberus (/), the
error has arilen of fuppofing a man to be cur'd of calculi, in whofe bladder
no longer any one offer'd itfelf to the catheter ; whereas in the body of the
fame man, after death, were found nine calculi, which fix facculi of the blad-
der contain'd. But befides the deceptions of the lithotomift, in fearching for
the ftone while this is, at one time, in the bladder, and at another time
withdraws itfelf into a facculus ; which is a circumftance whereof I fpoke
pretty fufficiently above (g) ; it may moreover fometimes happen, to the
great detriment of the patient, and of the reputation of the lithotomift, that
the calculus, which was very evidently perceiv'd in the bladder, fome days
before, may in vain be fought after in the bladder now, that a fection is made
into that cavity.
(4) N. 30. (/) Epiil. ad Haller de Medkamento Ste-
(() Tab. 32. fig. 1 & 2. phens.
(I) Loco indicat fupra ad n. 30. {g) N. 10.
(<•) Conunerc. Litter, a. 1736. Hebd. 5.
n. a.
Where'ore
Letter XLII. Article .32. 519
"Wherefore in patients of tins kiiul, in whom a calculus is fometimea fell
by the catheter, and fometimea not felt, he who felt it before ought to pn
fcribe many various kinds of motions, and potlures, to the patient, if another
lithotomiil does not feci it at any time: and much more ought he himfelf
to take care not to cut without feeling it, in the cavity of the bla Ider, at
very time of cutting. Thefc circumftanc.es however happen when the ori-
fice of the facculus is pretty large in proportion to the bulk of the calculus,
as it was in our rudic.
But the orifice and fac both grow large, from the quantity and weight of
the urine, to which the weight of the calculus mud likewife be added ; as
this has the more matter to concrete round it, and increaie it, in proportion
to the quantity of urine that stagnates about it : and the more urine remains
in the fac, in proportion as the calculus is increas'd •, for by this increaie the
coats that compofe the facculus are more diitrafted : and their elallic, as well
as mufcular, force, whereby the expulfion of the urine would be help'd for-
wards, are greatly broken, and diminifh'd.
"Wherefore the fac may be, fometimes, increas'd to fuch a degree, in its
magnitude, as to be miftaken for another bladder. But I do not fay this*
becaufe I am ignorant that the bladder has been, fometimes, really double
from its original formation ; as I know that it has not only been three-fold,
but even five-fold.
For it is certain, that Molinetti (b) has publicly demonftrated five in a wo-
man, who was likewife fupplied with as many kidnies, and fix ureters; two
of which were inierted into the larger bladder, and the four others into tha
four lefier bladders, into each one : which bladders difcharg'd their urine into
the larger bladder by peculiar tubuli ; a very rare inftance certainly, and
perhaps the only one of the kind ; and fo much the more worthy to be taken,
notice of by me, in particular, as out of all thole who refer to obfervations
of a double, or triple bladder, that I remember to have read, the celebrated
Fantonus (/) is the only one by whtfrn the lead mention is made, from Moli-
netti, of this quintuple, or five-fold bladder.
Nor does it efcape me, that, from the firfl formation of the animal like-
wife, the cavity of the bladder is fometimes divided into two, by a kind of.
feptum; whether that feptum be plac'd longitudinally, or tranfverfely : tranl-'
verfely Ruyfch (k) faw it in fome fheep and calves, as Blafius {I) had feen it in
the fame animals, and, as I fuppofe, in the fame manner : although the- fe-
cond cavity feems rather to belong to the dilated urachus than to the bladder ;
wherefore, as he himfelf hints (m), it is generally met with in quadrupeds
only ; and that which Blafius («) once found in the human body, was very
fmall : but longitudinally, as the fame Blafius (o) faw in another man, in
whom, however, he found, by an accurate difiection, that it was rather two
bladders conglutinated into one, by thejundtion of their fides, than one di-
vided by a feptum.
Yet what kind of a feptum that was, and how fituated, which Bauhin (p)
(k) Difiert. anat. Pathol. 1. 6. c. 7. in fine. (//;) Obf. 8. modo cit.
(/) Anat. Corp. Hum. Diflert. 7. («) Part. 4. obf. Med. 18.
(A) Cent, obf anat. Chir. 8. & MufxiTheca (0) Ibid. obf. 19.
A. Repof. 2. n. 1. (/) Theatr. anat. 1. itC. 31. not. k.
(I) Comment, in Synt. Veiling, c. 5.
520 Book III. Of Difeafes of the Belly.
fays was found in the body of a prince, does not appear clearly to me. This,
however, appears, that what fo many authors affert to have been found by
Coiterus in the body of a virgin-, whom I have had occafion to fpeak of al-
ready -, none of them would have afferted, if they had read Coiterus a little
more attentively.
For this author (q), without making the leaft mention of a feptum, has,
indeed, firfl faid, that in this virgin, " he had found two urinary bladders ;
" the one natural, and plac'd in its ufual fituation, the other proceeding from
" the neck of the matrix, on the right fide ; being almoft twice as big as
*' the natural bladder, very full of urine, and like the natural bladder
* furnifh'd with two coats : yet that here no meatus was feen, either to
" bring in, or carry out the contain'd water."
But below-, where he fays it may be inquir'd, "how this preternatural blad?
" der was generated, and by what paffages the urine enter'd into this appen-
*' diculated bladder •," he anfwers, " it was not furprizing, that in this vir-
" gin, who labour'd under a diforder of the uterus, and had her menftrual
" purgations, in a difeas'd and irregular manner, this thin and tranfparent
" water fhould be collected betwixt the membranes, which are found in great
" number, in the lower belly -, and that this water, by expanding thefe mem-
** branes, as happens in other places, fhould have form'd to itfelf fuch a bladder,
*' or refervoir ;" fo that it muft be clear to every one, that he has not, in
fa 61, defcrib'd a fecond urinary bladder-, which had exifted as congenial to
the fii ft formation of the animal -, but a large hydatid, which had been, at
length, generated by the force of difeafe.
How could it happen then, that Riolanus (r) fhould afTert, that Coiterus
had found a double bladder, in that virgin, " both of them being full of
" urine, but one only furnifh'd with ureters, which difcharg'd its portion of
** urine into the other?" Or even that Thomas Bartholin (s) fhould fav,
*' that the bladder has now and then two cavities, diftinguifh'd from each
" other, by a membrane or feptum -, fuch as Volcherus Coiter found in a
" girl of five and thirty years of age."
And if Tulpius (/) had not, foon after, follow'd him in repeating the ftory
of this fuppos'd feptum of Coiterus -, and Blafius (u) likewife, who exprefly
mentions Bartholin ; the fame miftake would not have run through fuch a
number of other books, and thole even the moft modern, which it is by no
means neceffary to particularize here : and the defire of removing this error,
has oblig'd me to be fomewhat more full on the fubjed, than I intended. But
I return to the matter in hand.
Where two or more urinary bladders, which communicate with one another,
are met with, and yet, from the particular mode of ftruclure, all of them do
not feem to have exifted from the original formation ; as, for inftance, if in-
to any one of them no ureter opens, nor this one feems, in brute animals in
particular, to be made up of the dilated urachus-, this bladder, I fay -, elpc-
cially if there is a calculus in it, or if a ftrangury, a dyfury, or a frequent
(q) Obf. anat. (/) L. 3. obf. Med. c. 5.
(r) Anthropogr. 1. 2. c. 28. (a) Comment, cit. in Vefliiig.
(s) In Additis ad Paths Inllit. anat. 1. i.e.
retention
Letter XL II; Article 33. 521
retention of a great quantity of urine, as frequently happens in drinkers, has
preceded ; is not to be confider*d as another bladder, but rather as a h
of the natural bladder-, that is a lacculus produe'd by the force of difeafc :
foch a one, ibr intlance, as I fuppofe that to have been, which Bartholin a:
(x) had been ieen in this theatre of ours, not by himfelf indeed, but by
IVloinichenius ; being fmall, growing to the larger, and communicating there
with.
Yet, on the other hand, I (hall fomewhat more readily confider in the light
of a double bladder ; as one ureter, at lead, open'd into each cavity ; that
which Stegmannus (y) defcribes in a young man, although labouring under
a dyfuria, an ilehuria, and a calculus. And finally, before I make an end of
ipeaking of thefe lacculi, 1 will alio lay, that thofe are to be attended to, which
appear before the bladder is inflated ; or which, if it is already inflated, can-
not be imputed to a hiatus of the external coats of the bladder, that the
knife has accidentally injur'd ; through which hiatus, the internal coats, being
fore'd outwardly, by the air that was blown in, rcfemble a facculus ; which
however had no exiltence in the living body ; and impofe upon the incautious,
or unexperiene'd anatomifts : and this is a circumflance that we have fome-
times obferv'd to happen.
33. As to the remaining circumflance, that the coats of the bladder were
become thicken'd, as we found them in the countryman (2) of whom I have
hitherto fpoken •, lb you might alio have obferv'd them to be in that coun-
try-girl (0), and in the young man (b), each of whom had been troubled
•with a very violent, obftinate, and long-continued difficulty of making
water.
To thefe add the bladder, which the celebrated Dethardingius (c) took care
to have reprefented in a plate ; and even thofe which you will fee in Ruyfch
{(1), and which you will read, had their parietes thicken'd, from the fame
caufe, to the extent of an inch i lb that, in confequence of this thicknefs, in
one of them, betwixt the parietes, and a large calculus, room was left only for
a few drops of urine.
And this was alio known to Riverius (e), who fays, that in carcafes of this
kind, the thicknefs of thefe parietes has been found to be " equal to that of
" a finger, or thumb •, fo as lbmetimes to fill the whole cavity of the bladder,
" and be almoft immediately in contad with the calculus itfelf." And not
to lead you away from the Sepulchretum ; although in that book (/") I alio
find thefe words taken from Riverius •, you will even read that in a child (g)
" they had been equal to the thicknefs of a finger's breadth ;" and that, in
another calculous patient (*), the bladder " had become externally flefhy:"
which circumftance #as likewife not unknown to Riverius, who (b), had re-
mark'd the bladder to have become " a flefhy body."
(x) Anat. quart. Renovat. 1. I. c 20. (<•) Prax. Med. 1. 14. C- 1.
(j) Eph. n.c. dec. 3. a. 4. obf. no. (f) Seft. 28 hujus 1. 3. obf. 19. & feci. 25.
(z) N. 28. in fchol. ad obf. 1. §. 8.
(a) N. 20. (g) §• eod.
(6) N. 15. (*) Ibid.*. 3.
(c) Eph. n. c. dec. 3. a. 9. obf. 31. (/•) Obf. 19. cit
(d) Cent. obf. Anat. CKir. 89. &c Thef.
Anat. 2. Aff. 3. n. 5.
Vol. II. X x x But
522 Book III. Of Difeafes of the Belly.
But thefe circumftances do not happen only when the dyfuria is from a calcu-
lus. For, not to fay, that, in reading over one of the firft obfervations of Hoff-
mann, refer'd to in the preceding letter (?')> you will alio find it to relate to the
prefent fu eject ; you have, at leaft, feen in the fame letter (k), that when there was
a dyfuria from an excrefcence of the proftate gland, the fibres of the bladder
werefo increas'd in their thicknefs, as to refemble the flrong fafciculi of the
heart •, when examin'd by Valfalva ; both in figure and magnitude : not to
take notice, here, of the obfervation of Picolhominus (/), which I am fur-
priz'd not to find transfer'd into the Sepulchretum •, I mean that of a girl,
who was afflicted with a continual fever, and very great pains, on account of
an erofion and acrimony of humours •, which, having depriv'd the bladder of
its internal coat, had left " the flefhy fibres of the external fo affected with
** inflammation, that you would have fuppos'd the whole of it to be flefhy -,"
fo far thefe fibres, fays he, " are fometimes irjarg'd, and render'd confpi-
" cuous."
And with this you will join the obfervation of Rud. Jac. Camerarius (m\ of
a bladder " like to a flefhy mafs," the parietes whereof being " of the thick-
" nefs of two inches, the cavity was fcarcely larger than a nutmeg," for that
reafon : and this you will be lefs furpriz'd at, when, in reading the hiftory which
I refer'd to above f«), from the Afla Hehetica,you (hall obferve that the coats of
the bladder were of fuch an immenfe thicknefs, that, although the bladder itfelf
was almoft equal to the head of an infant, the cavity of it, neverthelefs, was
fcarcely capable of admitting a nut.
And as I have juft now faid that the fibres of thefe coats are fometimes like
the lacerti, or fafciculi, of the heart, I would not have you be ignorant that
the fame comparifon was chofen by Valfalva ; and not by him only, but by
other obfervers after him alio (0), who have lit on the like appearances.
Nor could you yourfelf, if you happen'd to light on a bladder fuch as the
celebrated Trew (p) defcribes, and gives a figure of; which, having its internal
coat confum'd, fhow'd, inftead of " the fibres of the mufcular coat, various
** fafciculi collected together, in a furprizing manner, and diftinguilliM
" from each other, by the interceffion of large lacunas ," you could not, I
fay, make ufe of any other comparifon. And yet the bladder, whofe fub-
itance was become thus thick, contain'd large and rough calculi.
But without calculi, as thofe of which I juft now fpoke, it was found by
Hottinger (<?), to be as thick as the little finger, when meafur'd tranfverfely ;
and to have fibres u very confpicuous, in confequence of their being in-
•* larg'd to the fize of a pretty thick cord :" and that on account of fo great
an acrimony of urine, that it excited " a very troublefome itching, in the
" hands " of the perfon who diflected the body : b^Genfelius alio (r), it
was found " thick" by reafon of ulcers, and an excrefcence in the proftate,
confining the purulent urine : and finally by Bajerus (j) ; not to add others
(;) N. 12. (p) Commerc. Litter, a. 1734. hebd. 6. n. c.
(k) N. 6. vid etiam. epift. 40. n. 4. (?) Eph. n. c. dec. 3. a. 9. & 10. obf. 232.
(/) L. 2. Anat. Prxlctt. 24. (r) Eorund. cent. 6. obf. 84.
(7/1) Eph. n. c. cent. 3. obf. 10. (j) Eorund. Act, torn, 3. obf. 122.
(*) N. 23.
(0) Vid. apud Brendelium n. 2. Programni.
fu^ra ad n. 18. cit. here •,
Letter XLII. Article 34. 523
here •, " of the thickneis of a man's thumb," becaufe it was internally ulce-
rous, and fo irritated from hence, that, by its frequent contraction, con-
ilringing the mouths of the ureters, and caufing the urine to (lagnate therein at
the lame time, it dilated all the remaining part of them to the fize of a man's
thumb ; and the pehes of the kidnies likewife, to an unufual fize.
And that we, alio, have more than once fcen a thickneis of coats in a
bladder which was not affected with any calculus, you have not only been
inform'd by the lall latter (/), but from others alio («). For without doubt,
whether, as in perfons too much given to drinking, the urine very frequently
folicits the bladder to difcharge it •, or any other caufe, whatever, acts the
part of a itimulus thereto ; in fo much the greater quantity does the blood
flow to the bladder, and increafe the thicknefs of the coats.
From other caufes alfo, then, the coats of the bladder become thick : al-
tho' much more frequently from a difficulty in making water. But, on the
other hand, I fuppofe this difficulty to be increas'd by fuch a thicknefs ; and
fometimes to be produe'd, or preferv'd, as I mall fhow in a few words,
after having fubjoin'd an obfervation, which, if it could have been made
perfect, would have been introduced in another letter, rather than in the pre-
sent.
34. A failor, who was fifty years of age, of a habit inclining to fatnefs,
given to drinking, and accuftom'd to make water with difficulty ; and for that
reafon, perhaps, fubject to a fcrotal hernia •, came into this hofpital, on account
of neither of thefe diforders ; but on account of pain of the fauces, which,
however, was not of fuch a kind as to prevent him from rifing out of bed
fometimes.
Having walk'd in the morning, therefore, through the hofpital, and foon
after gone to bed again, he was found dead therein •, his face being black,
though afterwards pale. The day after, the body, being Hill warm, was
brought into the college, where I had begun to teach anatomy j it being
about the end of January in the year 1733.
The belly being open'd in the manner I thought proper, the omentum was
found to be drawn up above the ftomach, and the neighbouring inteftine
colon : the liver was variegated, like a fine marble, with redifh and whitifli
ftreaks •, and was rather large : but the fpleen was ftill larger in proportion,
and yet not very large.
The kidnies and ureters were in a natural ftate ; yet the bladder was in-
larg'd, and had its coats much thicken'd. The urethra was quite free from
marks of diforder in every part, although the corona glandis feem'd to have
been formerly affected with little ulcers, at the termination of that and the
preputium, from fome cicatrices which remain'd. The hernial fac was feen
in the fcrotum, but was empty.
The trunk of the great artery was, in fome meafure, tortuous where it lay
upon the vertebra of the loins •, as the trunk of its iliac branch, which had
a bony hardnefs in fome places, and whitifli fpots internally, was alfo : but
the aorta had the fpots only.
(?) N. 13, (") Hjiift. 4. r.. 19. & epift. 10. n. 19.
X x x z In
524 Book III. Of Difeafes of the Belly.
In the thorax we found a heart very much inlarg'd. Therein the femi-
lunar valves were in Tome places very hard-, and the fide of the anterior mi-
nal was not without bone. And although from the vena cava, when cut in-
fo at the leptum tranlverfum, a great quantity of black and fluid blood had
been dikharg'd ; yet in both the ventricles of the heart were polypous con-
cretions, of a pretty firm compages, and of a white colour, internally, in-
clin'd to cineritious, of which, that on the right fide, being the thickeft,
was produc'd far into the pulmonary artery ; and the other into the aorta to
no inconfiderable extent.
And the great artery ; whofe trunk feem'd to be univerfally wider than is
natural, being diftinguifh'd here and there, on its internal furface, with,
whitifh fpots (fuch as I have fpoken of) from the diaphragm quite to the
heart •, appear'd to be the more frequently fprinkled with thefe fpots, the
nearer it approach'd to the heart : fo that where it is hollow'd out with the
three lefTer finufles of Valfalva, it orfer'd, to the view, fpots that were much
more evident, and would have been foon chang'd into bone.
Befides certain parts betwixt the heart and the curvature ; which part ex-
tended more than three inches in length, and two in breadth •, it was,
likewife, internally unequal with thick, and almoft tortuous, rugae : nor were
flight marks of erofion wanting. However, through the carotids the fpots
were not propagated ; and much lefs the other diforders : fo that I was the
lefs difpleas'd to find, that, while the accurate anatomical examination of
thefe parts I have fpoken of, as well as of the others, took up the fpace of
lbme weeks, as they generally do ; and while other parts were, in the inter-
mediate time, brought in from other bodies •, the head of this was buried
without my knowledge : fo that I could not inquire after the eaufe cf the
fudden death therein.
The pharynx, which had been taken off", and left behind, together with
the larynx, I did however examine. And the larynx, as well as the whole
afpera arteria, and the lungs, were foUnd. I found the fides of the pharynx,
of which I faid the man had complain'd, to be thicker than natural : and by
cutting into this thicknefs, I faw that it was owing to the fubftance of the
pharynx itfelf ; which being more diftended, feem'd to refemble fomewhat of
a middle nature, as it were, betwixt glandular and vifcid.
35. If you diligently attend to thofe circumftances that relate to the urinary
parts, which are the only objects of our prefent confideration ; you will cer-
tainly perceive that there was nothing, to which the difficulty of making water
could be imputed, but the extreme thicknefs of the coats of the bladder.
That, however, which is produc'd in the Sepulchretum, from Guarinoni, and
in the additamenta to this twenty-fifth fection (x), has not efcap'd my notice r
for its intention is to fhow that the thicknefs, of which we are fpeaking,
'* does not always prevent the difcharge of the urine •" as is laid down in
the argument prefix'd to that obiervation.
But befides that Guarinoni, if I rightly conceive of his opinion from a very
few words, is not to be underftood to refer to a dyluria, but an ifchuria;
which at length happens, when this thicknefs and hardnefs have come to their
(*) Obf. 19.
4 higheft
Letter XLI1. Article 35. 525
bigbeft pitch ; I would alfo have you attend to this, that I do not fuppofe
even a dyfuria to be owing to every kind of hardnefs •, as, for inflance, when
this arifes only from the fubilance of the flefliy fibres being naturally enlarg'd,
which renders them Hill more proper for contraction •, but from that which
not only enervates thele fibres, by the interpofuion of foreign juices, but
caufes an infarction of all the remaining coats of the bladder to fuch a
degree, as to render them lefs flexible ; and, for that reafon, makes them
obllrudf. the contraction of the bladder.
And indeed, if you read over, out of the obfervations which are taken
notice of above (_v), thole in particular, which I pointed out from Camera^
rius, and the AH a Helvetica ; you will clearly perceive that thofe very, thick
bladders, were either of a fubilance which was " fibrous " indeed, bur.
c< fcirrhous i" or atleaft hard and callous: lb that notwithstanding they were
not all " every where agglutinated to the pelvis •," as that of Hottinger's
was ; yet they had much difficulty in contracting themfclves : from whence
finally thofe trainings, and endeavours in making water.
And thefe we may fee from the fame caufe, frequently, even in calculous
perlbns alfo ; unlefs by reafon of the weaknefs of the fphihcler, the urine fome-
times flows down fpontaneoufly. So the bladder of the man whom Mauchar-
tus (2) has defcrib'd, was " thick and almofi: callous." Thus, in a nobleman
of Piftoia, the celebrated Targioni (a) faw the coats of the bladder an inch in.
thicknefs, callous, and full of fteatomata ; fo that, as they could not be dif-
tended, they could contain only a very fmall quantity of urine, betwixt them-
felves and a large calculus.
And as a narrownefs, and coarctation, of the bladder, are generally join'd
with a thicknefs of the coats; as appears alfo from the example of Fantonus
(^), taken from a man, who, after a long dyfuria, from a calculus of the
bladder, appear'd, upon difiection, to have the ureters very much enlarg'd
indeed ; but of the bladder itfelf, " by reafon of the very great contraction, to
44 have a very fmall capacity ;M hence it is, that, if they attempt to obtain a
cure, they are often fubjecl to more confiderable uneafineffes, and dangers.
For the neceflary motion of the catheter, when introdue'd, being by this
means prevented •, either the calculi cannot be properly inquir'd after (as is
faid by Laubius (r), in a man whofe bladder was " very much conflicted,
*' and thicken'd") •, or if the furgeon make ufe of violence, the patient can
by no means bear it •, as we read in the work of the celebrated Schreiberus
(d), in the cafe of another perfon, whofe bladder,, being " extremely con-
'* traded, had juft accommodated itfelf to the fize of the contain'd calculus,.
*' and was much incraflated," fo as to leave " no room" for the catheter to
'* turn itfelf in, when introdue'd.
And when the bladder is cut into, that may fometimes happen, which.
Schrcckius faw (e ) even in a dead body •, I mean that " the bladder being.
14 very thick, and conftricted about the calculus, the calculus could fcarcely
" be mov'd from that place, and extracted from the pelvis." To this add
that if the bladder " has been rendered extremely narrow, from a calculus
■>r
!»
5 .
(y) N. 33. (f) Eph> n. c. cent. 8. obf. 22.
(z) Eph. n. c. cent. 7. obf. 1 j. (d) Epift. fupra ad n. 32. cit.
ia) Prima Raccolta di Oflervaz. Med. (e) Eph. n. C cent, 10. obf. 100.
(£) De Obferv. Me J, & Anat. ep. 8. n. 15.
there
526 Book III. Of Difeafes of die Belly.
there is no room for the method of cure us'd by Foubert, without danger
of a very confiderable error, as the celebrated Kefielringius (f) has aliened ;
and as Aug. Fred. Pallas (^) has very well confirm'd : even when this method
-is affifted by a certain circumftance.
And this he alio obferves of Rau's method, even with the addition of a
new inftrument (t), and in the high apparatus, as they call it, he has ex-
prefly admonifh'd us ft), that it is requifite the bladder mould be "found
" and large."
But what we have hitherto faid of the great diminution, for the moll part,
of the capacity of the bladder ; join'd with a thicknefs of the coats, and a
difficulty of extenfion ; is not only of importance to the lithotomift to con-
fider, but greatly to the phyfician.
For, by way of example, if a perfon, fubject to a dyfuria, is feiz'd with a
fuppreffion of urine in the bladder j he will not eafily naffer himfelf to be
impos'd upon by the appearance of a fmall tenfion of the hypogaftrium •, as
a furgeon I have already taken notice of did ( k) •, fo as to believe that it is
not yet time to draw off the water by the catheter.
For from a flight, but very troublefome tenfion, in that part, he will con-
jecture that there is already as much urine in the bladder, as a narrow, and
but little extendible, bladder of this kind can contain •, efpecially if the pa-
tient be pretty far advanc'd in years, fo that it may feem very probable for a
hardnefs and rigidity, from old age, to be over and above added ; and if, be-
fore the fuppreffion, he had been accuftom'd to make water very often, and
but little at a time. I never repented of having been induc'd, by the confi-
deration of thefe things, to accelerate the drawing off of the fupprefs'd urine in
time.
36. Although this letter is already carried out to a great length, yet if we.
would comprife the other diforders, which relate to difficulty in discharging
the urine, in the fame letter •, as I have promis'd in the beginning ; we muff,
of courle, touch upon many things in a curfory manner.
Firft then, to the other caufes of this difficulty, whereof I have hitherto
treated, thole alfo mull be added, which are to be met with in the urethra.
That the proftate gland, which comprizes the beginning of this canal, may,
by being indurated, and growing out into a preternatural fize, not only ren-
der the difcharge of the urine difficult, but totally obftrucT: it, has been fhown
in the preceding letter (I).
But when, from an ulcer and confln'd pus, this gland at the fame time
grows callous, and fwells ; it may fometimes happen, that, by the effufion
of the pus, the internal furface may be decreas'd in its fubftance, and the
fwelling fubfide •, and even that being eroded with ulcers, it may leave fo
much the more open a paffage for the urine, becaufe a callus, in the fame
manner as the fcirrhus of the proftate, remark'd by the very excellent Hau-
ler (m), prevents the action of the fphin&er in conftringing the orifice of the
bladder.
(f) Difl'ert. de Hift. &Meth "Foubert. n. n. (/) Ibid. $. iS.
fg) Difiert. de variis calculi, fecandi Me- (t) Epiit. 41. D. 14.
tliodis §. 39. (1) N. 13. 14. 17. & feq.
(b) Ibid. §. 29. (m) OpuVc. Pathol, ebf. 35.
4- A-t
Letter XLII. Article 36. 527
At this time therefore, a ftillicidium of urine will be brought on ; as in the
©bfervation of the celebrated Fantonus («), which I think may be thus ex-
plain'd. But when the cafe is at one time as I have juftdefcrib'd, and at an-
ther time, the difcharge of the new pus, from the proftate, is prevented ;
and from hence the internal furface of the gland again becomes tumid, be-
low that upper callus ; lbmetimes a ftiJlicidium or urine will be the confe-
quence, and lbmetimes a difficulty of difcharging it: and this latter, fre-
quently, will be fo confidcrable, as to degenerate into a fuppreflion full of
clanger-, which danger will be the greater, if either the inflammation, or the
hardnefs, and tumour, of this gland, forbid the uie of the catheter.
Thefe circumftanccs have not only occur'd toothers, and lbmetimes to
myfelf, in the practice of medicine •, but had occur'd alfo to Valfalva, I fee,
in the cate ot a certain knight, for whom writing an opinion in the year
17 14, he anl'wer'd, that, a a fuppreflion of this kind happen to be brought
on ; and it is not poffible to open the natural paffage for the urine ; what had.
been propos'd by others was alfo approv'd by him : I mean that they Ihould
open a new paffage, by forcing a proper inftrument through the perinxum
with dexterity.
And indeed, he moreover added, that if any thing mould happen to for-
bid the performance of this operation ; neceflity then obliging us to attempt
fomething •, we might draw out the urine, by plunging in the trocar, us'd in
the paracentetic of dropfical perfons, immediately above the offa pubis ; and
palling it obliquely downwards to the bladder : and this I was willing to ob-
ferve, that you might alfo know, what he thought of both thefe methods of
relief; if the urine cannot be drawn out in any other manner ; fo that the life
©f the patient may be, in the mean while, preierv'd, till art, or nature, fhall
open again the natural paffage of the urine.
For as to the puncture in the hypogaftrium •, Weitbrecht (0) wrote toGoet-
2'ius, that it was " commended by lbme and blam'd by others," when per-
form'd in a certain foldier at Petersburg •, and that he kit it to be determin'd •
by the furgeons, " whether this method deferves blame, or praife and imi-
*4 tation :** but certainly, for ten days this operation had been of much ad-
vantage, till the other parts, and, among thefe, thofe alfo which had been the
eaufe of the fuppreflion of urine, were likewife the caufe of death ; the
difl'ection fhowing the diforders of thefe parts, but not the leaft injury of
thole through which the inftrument had pafs'd •, and confequently confirming
the opinion of thofe excellent authors, who had before recommended it :
though perhaps, at that time, they were not fo well known in general.
But as to the puncture in perinaso ; I fuppofe Valfalva was not ignorant,
that his college, of Bologna, furnifh'd him with an authority which he might
follow-, I mean Zecchius •, who was formerly a very eminent phyfician, and.
who wrote upon the fubjedt to Rota (p), in fuch a manner, as to {how that
he believ'd himfelf to be the inventor of that happy remedy.
And although Riolanus (q), where he commends that upper puncture, and
this inferior fection likewife •, and this if there be neceflity even at the fide of
(n) Epift. fupraad n. 35. cit. 8. n. iS. (p) Confult. Med. 58.
(c) Comir.erc. Litter, a. 1733, hebd. 2. n. 1. (?) Enchciiid. anat 1. 2. c 50.
4 rira
528 Book III. Of Difeafes of the Belly.
the peringeum •, in which he has his followers even now, who make ufe of the
fame inftrument there, that they ufe in the hypogaftrium •, although, I fay,
he objects to Zecchius, that this remedy had been made ufe of " by the Pari-
" fian phyficians, already, for a hundred years •," yet Zecchius, though he
was a very young man a hundred years before, was neverthelefs of fuch an
age, that lie might have learn'd it from nature herfelf ; and by nature he fays
he was " taught ;" when, " an abfeefs being ruptur'd " in the perineum,
in calculous perfons, which abfeefs " had been fpontaneoufly form'd there,"
he had ken " that all the pains, and difagreeble fymptoms, in making water
" were remov'd."
37. That anfwer ofValfalva, of which I fpoke juft now, is to a fur^eon of
Lombardy, who, confulting him in the patient's name, had alio, among
other things, kiform'd him of this circumftance ; which deferves to be taken
notice of here •, " that he remember'd to have found a ftone in the proftate
M gland, when he diffected the body of his eminence the cardinal Morigi."
For this is the difeafe of which Chriftopher Pohlius treated, when hepub-
lifli'd a difiertation, at Leipfic, in the year 1737, De prqftatis calculo affebTn ;
examining the difeafe with a laudable defign certainly •, from which, befides
a dyfuria, and a frequent ftimulus to make water, other inconveniences may
arile, and among thefe pains either in the affected part, or even in the whole
urethra; in confequence of its not being fufficiently guarded againft the acri-
mony of the urine, by reafon of the quantity of invifcating humour in the
proftate being much diminifh'd, or the nature thereof vitiated.
It v/ere to be wifh'd that the old man (who had been a porter in his life-
time) in whom Pohlius found thofe calculi, had had none in the kidnies •,
and even had had thefe parts perfectly found : and that there had been no con-
fiderable marks of inflammation ; even in the lower part of the bladder itfelf,
above the proftate gland ; but particularly that no tumour, arifing from the
gland itfelf, had been internally prominent about that part, to the bignefs of
a cherry •, and fimilar to a fcirrhus, except that it abounded with pus.
That is to fay, we are at liberty to doubt, whether all the figns of the difeafe,
which Pohlius collected from the friends of the deceas'd, with great care and
prudence, were the effects principally of thofe calculi: as you might, with
verv good reafon, doubt, whether fome of the fymptoms delcrib'd above,
by me, in Cortini (r), fhould be refer'd to that tartareous, and almoft calcu-
lous matter, which was contain'd in a certain finus within this gland.
And in another man •, of whom mention will be made by me, on account
of the peculiar and original constitution of the preputium and glans •, when I
found certain yellow, and fmall calculi, fix'd up pretty high in the proftate ;
I could not poflibly learn, what inconveniences had been occafion'd to him
therefrom : and that by reafon of his being a foreigner, who had been taken
into this hofpital, on account of a very acute and fatal inflammation of the
thorax.
This however I perceiv'd -, that there could be no emifTion of femen by
any means : as the calculi were fkuated, and fix'd, in fuch a manner, as in-
tirely to prevent its difcharge. And this obfervation brought to mind others
(>) N. 13.
0 that
Letter XLII. Article 37. 529
that I had read. For Marcellus Donatus (s) has laid, that a man, in whole
proftate he found ;i ftonc infix'd, " could not difchargc lenien, in coituy ex-
" cept in a very fmall quantity, and very watery."
And Frederic Loflius (/) tells us, that the caufe of fterility, or impotence,
fometimes is '* a calculus very clofcly fluitting up that meatus, which opens
•• from the probata; into the urethra." And among thefe authors it feems
proper that we fliould reckon Nicolaus dc Blegny (») ; who relates that the
ejaculation of the femeri had been, in like manner, prevented, in another
man, on account of the leminal caruncle being become tumid and hard -, be-
caule the femen " had been there harden'd into a (lone, and the vafa ejacula-
" toria were full of very hard ftones," molt of which were of the fhape and
fize of a pea.
And Fabricius Bartholetus, who ought to have been mention'd be-
fore, obferv'd, according to the relation of Rhodius (x), that, in the pro-
ftate, " a calculus had been generated from retain'd femen •, and the orifice
" of the bladder being comprefs'd thereby, the urine was prevented from
" flowing down." But I wonder that Rhodius, and Bartholin (y), when
taking notice of this obfervation, mould, contrary to the cuftom of both of
them, omit to mention that which I have, in the firft place, pointed out
from Donatus ; not to fay that I am furpriz'd they fhould omit another, which
is in the fame author Donatus (z), " of a very fmall ftone," found in the
proftate of a phyfician of Mantua.
And Terraneus (a) even relates, that he had obferv'd, in an old man ;
tc who was calculous in his kidnies, his fpleen, and his lungs •, fmall and un-
" equal calculi in the tubuli of the proftate, and in thofe of the vafa defe-
>* rentia which ejaculate the femen at the beginning of the urethra; which
" calculi caus'd uneafinels, and obftruclion, both in refpect of the urine,
" which was to fall from above, and of the femen when about to be dif-
" charg'd."
And before him James Douglafs (b) has aflerted, that he had found, in
another old man, " fome fmall hard bodies, fimilar to white peas ; as to
" confiftence correfponding with the body before mention'd" (that is to fay,
with one found in the tumour of a woman, which whether it was bony, or
rather ftony, or tartareous, he left undetermin'd) " but more polifh'd, as
" to the external furface •, fome of which lay upon the very body of thefe
" glands" (that is the proftate) " while fome adher'd, by fmall roots, to
" the membrane which cover'd thefe glands."
On thefe obfervations then, I was willing to take notice of to you here, not
becaufe they are not commonly enough known •, for many of them are trans-
fer'd into the Sepulchretum (c), although fome in one place, and fome in
another ; but that you may add them to the obfervations of Pohlius, and
ours: although from none of them, a fufficiently peculiar fign can be drawn,
in order to diftinguiih calculi of the proftate.
(s) DeMedica Hift. Mirab. 1. 4. c. 30. (a) De Gland, c. 5.
ft) L. 1. Obf. Med. 33. (/>) Vid. Aft. Eradit. Lipf. a. 1707. m. Fe-
(«) Zodiac. Med. Gall. a. 2. Mart. obf. 4. bruar.
(x) Cent. 3. Obi". Med. 27. (c, L. 3. feci. 24. obf. 17. §. 4- & <"e^- 34-
(y) Cent. 4. Epift. Med. 6. obf. 5. §. 4. & obf. 6. ^. 1. &inadditam obf. 3.
(«) C. 30. cit.
Vol. II. Y y y For
530 Book III. Of Difeafes of the Belly.
For, although in mod of thofe which I have quoted, the ejaculation of the
femen was prevented •, yet this does not happen from every calculus of the
proflate, nor from thefe alone : for neither are all of them in fuch a fitua-
tion as to be able to obflruct, or comprefs, both the feminal ducts, nor does
the obftruclion, or compreflion, of thefe duels, fail to be brought on, fome-
times, by other caufes.
But may we fuppofe thefe fame calculi to be fometimes generated, among
other matters, from that alfo which we very frequently meet v/ith, under the
appearance of granules of tobacco, within, or about, this gland, when we
cannot fufpect them to have been form'd of the feminal matter ? You will be
able to judge, of yourfelf, when I (hall fpeak both of that matter, and of the
finuffes that fometimes contain it, and of the other diforders of the proflate,
in treating of the gonorrhoea (d).
38. In touching (lightly, at prefent, upon fome of the diforders, which are
alfo common to the other parts of the urethra •, I (hall by no means repeat
what has been faid of calculi, which I have already (e) defcrib'd, as found
under the internal membrane of this canal, in the body of a woman.
We fhall rather fay, what appearances have ofFer'd themfelves to us, in the
whole of the urethra (in fo great a number of bodies, that we have difiected)
which may relate to the controverfy concerning the nature of caruncles •, for
fo they are call'd ; which almofl every body formerly fuppos'd to be gene-
rated therein, efpecially if a virulent gonorrhoea had preceded ; though now
this opinion is embrae'd by very few •, and the difficulty of making water, a3
well as the obflructions the catheter meets with, and which they attributed to
caruncles, have different caufes aflign'd for them at prefent by different per-
fons ; and among others cicatrices in particular, or turgid and varicofe blood
veffels, that caule a coarctation in fome parts of the urethra •, to which lad
kind the twenty-fecond of thofe obfervations, which are added to this twen-
ty-fifth fection of the Sepulchretum, likewife relates.
And even the corpus fpongiofum urethras itfelf, is faid to protuberate
within the cavity of this canal in that part •, where the gonorrhoea has pretty
much weaken'd fome parts of the internal coat.
And as this coat is fo thin, you will, I apprehend, be lefs furpriz'd, if it
does, at any time, give way to the force of the blood, which diftends the
cells of that body ; as the parietes of the corpora fpongiofa penis, which
are fo much more thick and (trong, are fometimes alfo rais'd up into a knot
of that kind ; as was formerly hinted even by Arantius (f).
The very experienced Goulard (g) thinks, that this kind of obstruction is
more frequent in the urethra, than others •, the exiflence of which however he
does not deny •, as it is more fitted, (which he demonftrates) to account for
the phenomena •, and among thefe, this likewife : how it happens, that, fre-
quently, no obftacle occurs in the bodies of fome perfons after death, who
have complain'd of them when living, even to the very day of their death.
That is to fay, the caufe which had fore'd thefe cells, ceafing in death ;
together with the power of the circulation of the blood ; they are by degrees
{d) Epift. 44. n. 20. & feq. (f) De Tumor, p. n. c. 50.
(*) Epiit. 33. n. 34. (^) Traite des Maladies de l'Urethra.
depleted,
Letter XLII. Article 38. 531
depleted, fubfide, and leave no traces behind, or at leaft none, that can
ftrike the eyes of the anatomical inquirer.
Neverthelefs, I believe that when they really did exift in the living body,
they may be fu ejected to the eyes after death, if the lpongy body of the
urethra be diftended by blowing-in air •, in the fame proportion as it had been
diftended in the living body by blood ; and if the urethra be dried in this
manner, and cut into : for then, without doubt, the place, within this canal,
will come into view, where the obftacle us'd to be perceiv'd.
However, fome are not wanting who ftill contend for the exiftence of ca-
runcles, in the feveral parts of the urethra •, but particularly would have them
allow'd of in the feminal caruncles itfelf, when tumid : among whom alfo
was Lancifi himfelf, in his letters to Genfelius (b) ; but no body has treated
the fubject more accurately, and at large, than Benevoli (*), who has
taught •, not only by referring to (as the former author has done) but even by
producing, the whole of his own obfervations j that this difeafe was in that
fame exulcerated caruncle.
Yet this author has not denied ; which I would wifh to have remark'd, by
one and another very learned author, confider'd in other views ; nay has even
exprefsly confefs'd (£), that there may be other obftacles in the urethra be-
fides; fome of which he alfo found from narrowneffes, corrugations, and c-
catrices ; and even fometimes from a kind of flefhy excrefcence : and he
contends only for this one thing, that all thofe peculiar figns, by which he
diftinguifh'd the difeafe whereof he was fpeaking, from other obftacles ; which
he was very well acquainted with, and which oppofe themfelves to the urine
and the catheter ; could not arife from thefe, as they did from the feminal
caruncle when ulcerated.
And if others take pains to fhow that thefe may be better diftinguifh'd from
each other, by certain marks -, as he has done in regard to his •, it is not to be
doubted but this muft be of great importance to the phyfician : as it is of
great importance to make different predictions in different kinds of obftacles ;
and at the fame time ufe a different kind of treatment ; or at leaft to avoid im-
proper methods.
You fee that I, in a controverfy which is in other refpects abftrufe, by rea-
fon of the obfervations being fo very different ; reject none of thefe, in con-
formity to the equity of Celfus, and the judgment of the moft excellent men.
" It is to be fuppos'd," fays Celfus (I) •, although fpeaking of another fub-
ject ; " that every perfon has omitted what has not come under his know-
" ledge, and that no one has pretended to fee what he has not leen."
And Aftruc (m), Heifter (»), and Platner (0), to whom you may alfo add
Waltherus (/>), do not doubt but there are different kinds of obftacles in dif-
ferent perfons ; nor do they fuppofe it of importance, whether every one has
(£) F.ph. n. c. cent. 6. obf. 84. («) Inftit. Chir. p. 2. §. <j. c. 38. n. i.
(»') Nuova Propofiz. int. alia Carunc, (o) Inftit. Chir. \. 1336.
{i) C. 2. & c. 3. (p) Differt. de Collo Viril. Vefic. & cart". §.
(/) De Medic. 1. 7. c. 14. 15. & feq.
(m) De Morb. Vener. 1. 3. c. 4. §. 4. &a-
libi.
Y y y 2 i'een
532 Book III. Of Difeafes of the Belly.
feen all thefe kinds : for it is enough that each of them is confirm'd by ob-
fervations upon which we may depend.
Thus we readily admit of the caruncle which Genfelius himfelf found {<j) ;
and not with lefs readinefs than we do of the ftriclures, and coarctations of
the urethra, feen by Brunnerus (r), and others. But I do not with equal
readinefs allow of all thofe, which each of thefe authors has added. Nor
are they all of them obfervations, relating to this fubjedt, but conjectures •, I
fay even thofe which are fubjoin'd, as obfervations, by Genfelius.
For what reference to this difeafe, have thofe (pu/aala of the urethra,
fpoken of by Hippocrates (\j), or " very fmall abfeeftes", as Celfus fpeaks (/);
which being fuppurated foon, as generally happens, " health is reftor'd,"
immediately, upon the difcharge of the pus ? Others, indeed, do relate there-
to. But has not every one, who fuppofes himfelf to have cur'd a caruncle,
at leaft brought the fame proof of his opinion, that Galen (u) produces ;
who having broken, with the catheter, a caruncle which " had arifen from
" an ulcer, faw not only fome blcod follow the excretion of the urine, but
" alfo fragments of flefh."
Thofe who have found caruncles exifling in the body after death, which
is the moll certain method of obferving them, are, when all taken together,
much fewer in number, than Genfelius feems to believe ; if you fet afide
thole, who, though they have feen flefhy excrefcences in the urethra, yet
have not feen them as form'd therein •, which is the fpecies we inquire after
here -, but have obferv'd them to be hanging down from the bladder, from
whence they arofe, into the urethra.
And this being the ftate of the queftion, you will, I fuppofe, be lefs fur-
priz'd if I fay, that, notwithstanding the great number of urethras, which I
have attentively examin'd, fince the time I firft gave myfelf to the fludy of ana-
tomy •, and the number I ftill infpect every year ; I have made but one certain
obfervation of a flefhy excrefcence •, whereas I have many of cicatrices, and co-
arctations ; and this one of excrefcence was not without thefe other fpecies of
difeafe.
39. A young man died of a wound in the head, in this hofpital, about
the middle of December in the year 1717.
The vifcera of the belly, the great artery, and the larynx ; in the exami-
nation of which parts I was then wholly taken up ; being firft accurately in-
fpected, and demonftrated to thofe who were prefent •, I found thefe preter-
natural appearances.
The ftomach was enlarg'd, and had fcarcely any rugse. The liver was
bigger than it naturally is •, as the hepatic artery alfo was. The kidnies had.
many cicatrices : but the glans penis ftill more •, as it was become very much
deform'd, and very fmall, by reafon of large cicatrices.
From thence, the urethra was very evidently much ftreighten'd, quite to a
third part of its length : nor did any of thofe larger canals, that I have defcrib'd
in a former work (x)y appear any where ; but their place was, in general,
(q) Vid. obf. 84. cit.
(r) Eph. n. c. cent. I. obf. 71. & 97.
(j) SecT;. 4. aph. 82.
(0 L. 2. c. 8.
(«) DeLoc. Aff. 1. 1.
(x) Adverf. I. 0. 10.
c. 1.
taken
Letter XLII. Article 40, 41. 533
taken up by an interrupted line, which a thin excrefccnce of luxuriant f<dh
compos'd.
The other part of the canal ; being cut open, quite to the bladder, and cxa-
min'd very attentively ; fhow'd no mark of dileafe : as the larynx did not in
like manner; if you except the epiglottis, which was not quite found. But
the great artery was internally unequal, and had marks of beginning ofiifi-
cation, and corrofion ; though fomewhat obfeure : befides, a little above the
heart, it was become much wider than is natural.
40. I differed the carcafe of an old man •, who was a foreigner, in the
fame place, and almolf about the lame time ; the other of whole diforders I
have not remark'd in my papers. That he had been infected with the ve-
nereal dileafe, as well as the young man of whom I fpoke jull now, the ap-
pearances, which I mall give you an account of, will fuificiently demon-
ftrate.
For when the belly was open'd, and I had found one of the kidnies very
large, the other more contracted than natural, and the ureter of this laft al-
molt univerfally dilated ; to fuch a degree, as to admit the point of my little
finger; and befides thefe, the bladder large, having its parietes thicken'd",
and purulent •, I turn'd my eyes to the urethra, and the penis. The glans-
penis was hollow'd out with many deep cicatrifes : and the urethra was very
much contracted, fo that I was fcarcely able to demonftrate, therein, one or
thofe fmall canals, which are fpoken of above.
The other parts did not feem to be preternaturally affected ; except that
the epiglottis was not perfectly found, and the neareft part of the tongue,
which is cover'd with glands, was here and there disfigur'd with little
ulcers.
41. As to the appearances which I obferv'd in the urethra of both thefe
perfons ; though it was eafy to perceive from what caufe they had arifen,
yet it was not in our power to know what effects they had produe'd : that is,
what inconveniences they had occafion'd in making water ; as it likewife hap-
pen'd in regard to other appearances, which, being found by me in other ure-
thras, by diffection, I have either given you the defcription of already,#or
(hall give hereafter.
For I mall tell you (y)t when I treat of the gonorrhoea (z), that, in a
young man who died of a wound in the neck, I had met with an oblong
whitim line, a little protuberant, going obliquely from the middle of the
urethra, towards the farther part of that canal ; as I alfo met with fome
other little chords in an afthmatic man (#), not without a contraction of the
urethra.
And I faid in the fortieth letter (b), that in an old man, who had been
taken off by the rupture of an aneurifm, I found the urethra cicatriz'd in fe-
veral places ; and fiores, befides, obliquely prominent, betwixt the feminal
caruncle, and the bladder: and in like manner in the fourth letter (c), that in
the ftable-keeper, who died apoplectic, I met with oblong whitim lines, ob-
liquely prominent, in two places of the urethra; and in one, at leaft, oppofr
(j) Vid. etiam epiil. 63. n. 13. (b) N. 29.
(■z) Epift. 44. n. 7. (c) N. 19.
(a) Ibid. n. 10.
ing
534- Bo°k IH- °£ D^eaf*es of the Belly.
ing themfelves to the probe when introduc'd : and finally, in the tenth let-
ter I have laid (d), that in the body of a paralytic man, who had been taken
off by convulfions, I likewife found certain oblique, and almoft flefhy, fibril-
lar, in that part of the urethra, where fome obftacle ufed to lie in the way of
the catheter.
Now if with that line, which I faid, juft now (*), was made up of a thin ex-
crefcence of luxuriant flefh, you compare thefe almoft flefhy fibrillar, and
thofe fibres -, and with both of thefe, in like manner, compare the oblique and
prominent lines ; you will perhaps fufpect, with me, that a kind of thin ex-
crefcences do now and then fucceed to fome certain erofions of the urethra,
which excrefcences, when contracted, firft refemble fibres, or flefhy fibrillas ;
but when more and more dried, do, at length, put on the appearance of
whitifh and fomewhat prominent lines : and therefore it muft have happen'd
to me, to have feen excrefcences of this kind frequently, if I could have in-
spected thefe urethras, while the diforder was more recent. Yet, on the
other hand, it is not abfurd, to fuppofe, that as I have more than once feen
the urethra cicatriz'd, and very manifeftly ftreighten'd ; fo thefe lines may
be, in fome meafure, the confequence of thole appearances.
42. I have frequently diflected, and accurately examin'd, the urethras of
women alfo; though not fo frequently as thofe of men. But hitherto I have
not lit on any one (unlefs you would perhaps except one, whereof I fhall
fpeak prelently) which had cicatrices, and much lei's excrefcences : nor is it
to be wonder'd at, in a very fhort, and not very narrow canal, into which
neither fo many humours, that have the power of eroding, are difcharg'd,
nor does any flexure happen therein, and ftill lefs fo much as is obferv'd in
the male urethra. Yet that in the female urethra, both ulcers and excref-
cence, or at leaft fome long-continu'd obftacles, may arife, I have learn'd
from Aflruc and Alghifi ; the former of whom (f) has more than once {een
the body, with which the female urethra is furrounded, fuppurated, and
fillulous, opening -within the urethra, and difcharging pus •, and, at other
times, that the urethra was immoderately ftreighten'd by the fame tumid and
caUous body ; and Alghifi (g) mentions a virgin, in whom a thin medicated
candle, that had been left within the urethra ; in order to deftroy " a carnofity "
of that canal •, had enter'd into the bladder.
Add to thefe the " flefhy excrefcence," which will be fpoken of prefently,
defcrib'd in a certain widow, by Mullerus (h).
And it happen'd once to me, when I examin'd the body of an old wo-
man, about the beginning of the year 1751, that I met with a fmall triangu-
lar excrefcence, within the external orifice of the urethra, yet not protube-
rant therefrom : and very often, but particularly after acute fevers, I have
obferv'd fanguiferous veflels •, which being in great number, and almoft pa-
rallel, creep through the internal coat of the urethra •, and thefe fo turgid,
and crowded together, that almoft the whole of this canal was black there-
from : and it happen'd once in a young virgin, and, in like manner, in an
old woman, of whom I fhall perhaps have occafion to fpeak hereafter {i)>
(d) N. 13. [£) Litotom. c. 3.
(«) N. 39. (b) Eph. n. c. cent. 8. obf. 38.
(f) %. 4. i'upra ad n. 38. cit. (/') Vicl. epiit 50. n. 51. & epift. 56- n. 21.
that
Letter XLII. Article 42. 535
that I faw a portion of this fame coat prolapsM on the outfide of the orifice
of this meatus.
But what inconvenience thefe laft-mention'd females, or the former, fuf-
fer'd in the difcharge of their urine, I could conjecture indeed, but not for a
certainty know.
In regard to the caufe likewife, why fome part of that membrane was fo
prominent, from the orifice of the urethra ; in the two lad fpoken of ; we
were only at liberty to conjecture it.
And as I was not willing to make ufe of that conjecture, which might have
been drawn from this orifice, and that membrane, having been frequently ir-
ritated by the head of a needle (&)> or bodkin ; another perhaps remain'd to
be drawn from a foregoing ftrangury.
For that this membrane is urg'd downwards, by very violent (trainings to
expel the urine, is not only hinted by reafon, but confirm'd by the obfer-
vation of Mullerus, that I have already quoted. For the excrefcence, which,
coming forth out of the orifice of the urethra, had ftop'd it up, being in
great meafure confum'd ; the remaining internal part became *' confpicuous
" only by that kind of draining, which we ufe in unloading the bladder."
"Which obfervation of an excrefcence, that was " flefhy, red, and fun-
" gous; and had come forth to the fize of a bean," from that orifice; if it
be join'd, by you, with another inftance, which the celebrated Goulardus (/)
mentions, of a " carnofity in the urethra" of a certain man, which grew out
to fuch a degree at fome times, that it came forth from the orifice thereof,
and was there to be taken off"; you will fo much the more readily join in,
opinion with thofe, who ftill acknowledge caruncles, among the other ob-
ftacles, that occur in the meatus urinarius.
But not to depart from the confideration of the female urethra ; what mall
we fay of that very rare obfervation of Corn. Solingen, which Salzmannus (»;)
takes notice of; I mean "of the meatus urinarius being inverted, and hang-
" ing downwards, to the length of a little finger ?"
Shall we fay that the membrane of the meatus was relax'd, and extended,
to fuch a degree ? Or that the neck, or lower part, of the bladder, was fal
len down thither, as Salzmannus (») feems to believe ? Who neverthelcis
propofes the following doubt (o) : " if fome other part, which ofFer'd itfelf
M to the eyes, did really not impofe upon Solingen, under the appearance of
" the bladder."
There is alfo another difeafe, to fhow the rarity of which in the female
urethra, I fhall hint at a few things concerning this canal ; and calculi dii-
charg'd thereby. The urethra of females, as Celfus (p) fays, and, as I juft
now laid down, " is both fhorter, and more lax, than in males ;" and, as he
had faid above (q), is, at the fame time, more direct in its pafTage."
A calculus therefore, as the fame author very properly fubjoins, " when
" it is very fmall, frequently falls out of itfelf." And fometimes ftones,
that are by no means fmall, are fpontaneoufly extruded this way -3 of which
{k) Supra n. 19. & feq. (o) Thef. 19.
(I) Traft. fupra aa n. 38. cit. (p) De Medic. 1. 7. c. 26. 114.
(») Diflert. deHern. Veiic. Urin. thef. iS. (q) Eod. c. a, 1,
(») Thef. 26.
2. kind
536 Book III. Of the Difeafes of the Belly.
kind was that I law here, as I have already written (r) ; and flill more thofe
that I faw at Bologna. Of which, or others ; that Langelottus (s), Jaeger-
fchmidius (/), Dillenius (it), Schmiederus (x), Trew (y), and others, have
fpoken of, as being extruded from the female urethra, without the affiftance
of iurgery •, it is of no importance to fay more: fince it is certain that Sen-
nertus (2), and Tulpius (a), have feen larger than thofe ; that is, the former
one " almoft of the bignefs of a lien's egg," and the latter one, as the figure
" which is added (hows, very thick, and weighing three ounces, and two
" drachms."
And this I believe to have been the largeft, among all of which I remem-
ber to have read : I fay among all, not only that have been difcharg'd by
women, but even generated in their bladders •, whereas I know, that, in the
male bladder, they have grown to an immenfe weight.
For 1 omit that which " weigh'd an Englifh pound, and two drachms be-
" fides, the like to which" Van Helmont " did not remember ever to have
" feen •," fince in the fame lection of the Sepulchretum (b), wherein thofe
words are related,*calculi of thirty-two (c), and thirty-four ounces, in weight, are
delcrib'd (d) : and the celebrated Targioni (e) afierts, that there is one at Flo-
rence, which weighs thirty-nine ounces; and this is, likewife, the more remark-
able, becaufe it was found in a man, who was carried off by a difeafe ; after
a healthy and flourifhing old age-, in which there were flight fufpicions of a
calculous diforder, rather than any real or true fymptoms.
And I fee that another of the fame weight is taken notice of by Verduci-
us (f), and from Launayus (g) another of fifty-one ounces : finally, that
your wonder may be carried quite to its height, confider that which Keflel-
ringius (b) fays he had feen in the pofieffion of the celebrated Morand, " equal
" in weight to fix pounds and three ounces:" which very weight; left you
fhould fuipect me of having made a miftake in the defcription ; you will al-
fo find in the reviewal of that differtation, publifli'd in the Commercium Littc-
rarium (i).
But from whatcaufe do you fuppofe it to happen, that we read of no fuch
large (tones being found in the female bladder ? Doubtlefs, I either am de-
ceiv'd, or the more direct, and fhorter pafiage, of the urine in the female
fex, as I have already faid, and particularly the wider pafiage, eafily receives
and emits the much greater part of that vifcid, and tartareous matter; which,
by reafon of contrary caufes, ftagnates in the bladder of the males, and is
continually added to the matter already concreted into a calculus ; whereby
its bulk is greatly increas'd : and this happens particularly in fome bodies,
who are moft difpos'd thereto.
(>•) N. 10. (b) 23. obf. 1. §.9.
(s) Eph. n. c. dec. 1. a. 6 & 7. obf. 7. (c) Obf. ead. §. 1.
(/) Dec. 3. a. 3. obf. 101. (d) Ibid. §. 2.
(«) Dec. ead. a. 9 & 10. obf. 242. (e) Prima Raccolta di OfTervaz Med.
(x) Cent. 3&4 obf. 161. (f) Vid. apud Boretium de opera:, alti ad-
(y) Commerc. Litter, a. 1733. hebd. 39. parat.
n. 4- {g) Vid apud Pall, differt. fupra ad n. 35.
(z) Med. praft. 1. 3. p. 8. f. 1. c. 2. verf. cit. in adnot. ad §. 19.
fin. {h) Diflert. ibid, fupra cit. n. 53.
(a) Obf. Med. 1. 3. c. 7. (/) A. 1739. hebd. 9.
2 For
Letter XLII. Article 43. 537
For which reafon we ought to confidcr as the more extraordinary, the cafe
publifh'd by the celebrated Adolphus (/•), " of an oblong calculus form'd in
" the urethra" of an old woman, " and firmly adhering thereto."
For by what means could the particles, of which this calculus confided,
remain in a canal of that kind, and not be carried away by the impetus of
the urine ?
Certainly, either the impelling force, by which the urine is driven, was
grown very languid, in a woman of threescore and fixteen years of age, or
the membrane of the urethra was, in fbme places, ulcerous ; and for that
reafon retain'd thofe particles within its winding finufTes, and inequalities : or,
finally, the calculus which was fir 11 generated in the bladder, and had, in
fome part, enter'd into the urethra, having been obftructed there, had frefh
and frefh additions continually made to it, of the fame kind of particles flow-
ing that way gently, and almoft drop by drop, as is generally the cafe; thefe
things, I fay, either all, or fome, might be fufficient to produce that which
is the object of our furprize, though the production is neverthelefs very extra-
ordinary.
And what favours this explication, befides the age of the woman, is the
preceding " obftruction of urine, for many years, at times at leaft ; but
" particularly the calculus itfelf bent back quite into the bladder. For fee
my firft obfervation (/), of the calculus which had been form'd upon a
needle, within the bladder of the virgin.
This calculus, as it had a part of itfelf bent back within the meatus uri-
narius, certainly had not begun from that part ; but on the needle, which
was at fome diftance from thence : and this very part had been gradually
form'd, within the contiguous meatus, as an appendix and additamentum of
the calculus ; fo that it was evidently to be confider'd as the end, and not the
beginning, of the calculus.
43. It would remain now, that I mould write of the Diabetes, of the in-
continence of urine, of its excretion through an indecent place, and of
urines that are not in their natural Hate •, each of which fubjects has a pe-
culiar fection allotted to it in the Sepulchretum.
However, I fhall not do this for two reafons. The firft is, that neither Val-
falva, nor 1, have diffected any one who died of a diabetes •, as you may, of
yourfelf, eafily conjecture, from what I hinted of this difeafe, in the former
letter (w). 1'he fecond is, becaufe I have already defcrib'd all the appear-
ances I have met with, in thofe who died after the other diforders, which
are juft now fpoken of-, and that at the fame time I treated of different dif-
eafes, on which they depended : as you may have obferv'd even in this very
Utter. And it is not our cuftom to repeat any thing.
But if this were not done in the Sepulchretum, thofe fections, that I
have fpoken of, would be redue'd fo as to contain much let's ; notwithstand-
ing the two firft are fo fhort, that both of them, together with the Scholia,
fcarcely fill fix pages. Befides, in almoft; every one which relates to the urine,
or the parts fubiervient thereto, not only the obfervations which had been
[&) A&.. n. c. torn. 1. obf. 259. {m) N- 14. 15.
(/) Supra ad n. 19.
Vol. II. Z z z given
538 Book III. Of Difeafes of the Belly.
given in other fections, are repeated, but they are fet down twice even in the
iitine fection.
You have learn'd already, from the beginning of the preceding letter (n)r
how many were repeated in the twenty-fourth fection. See then, I befeech
you, whether in the twenty-third ieition, which precedes that, the things-
whereof we read in the firft article of -the eighth obfervation, are not the
fame that we read partly in the ninth obfervation, and partly in the Scholia
which are fubjoin'd to it: and in the fection, on the fubject of which I am
ftill employ'd, that is the twenty-fifth, whether what had been given under
article the fecond, and tenth, of the eighth obfervation, are not fet down
again under article the nineteenth, and article the feventeenth, of the fame ob-
fervation.
But even in one of thofe very fhort fections, that is in the twenty-feventh,
is not what is faid under article the third of the firft obfervation, the lame
that is faid under article the ninth of the fecond ? And in this very fecond ob-
fervation, is not article the fourth the fame with article the eleventh which
follows ? If you are inclin'd to doubt it, only examine the hiftories, as they
are related at large, in the twenty-fourth fection, obfervation the tenth,
article the eighth, and obfervation the fecond, article the fourth ; on reading
of which all your doubts will be remov'd.
Finally ; not to take up your time with too many flrictures ; if you turn
over the twenty-feventh fection, you will find, not without great furprize,
that the very fame things which have been faid a little above, are twice re-
peated below, in one and the fame page; that is to fay, firft the greateft part
of the Scholia to the fixth and feventh obfervations ; and after that, under
the twelfth obfervation, the hiftory of the illuftrious dutchefs, article the
fecond and fourth.
44. Yet, left we mould feem to pafs by thefe fections, without taking any
notice of them, I will remark a few things, in regard to that laft, which re-
lates to urine in a preternatural ftate ; and not much more, in regard to the
laft but one ; which I have faid relates to the excretion of urine through an.
indecent place. For both thefe kinds of remarks may not be without their
utility ; though they will have no direction join'd with them.
I have fometimes lit on urine which feem'd to have chyle mix'd with it,
and fometimes on that which feem'd to have blood ; fo that fome phyficians
contended that the circumftance was to be confider'd juft as it appear'd ; but
others that it was to be underftood very differently.
That firft controverfy was agitated here about forty years ago, to a very
great degree ; when the laft of the noble family of the Difcalcis; in that long
difeafe of which he at length died ; continu'd to difcharge urine, for a long
time, the greater part of which feem'd to be perfectly like milk.
One of his phyficians-, a very eminent man, who was join'd with me in
the office of profefibrfhip in the college, and was my intimate friend ; hav-
ing obferv'd that fediment to be quite free from fmell and vifcidity, aiferted
it to be chyle. The other denied this, and contended for its being pus.
In order to fettle this long and obftinate difpute, every one, at Padua,
(») Epift. 41. n. 1..
2 who
Letter XLII. Article 44. 539
who had then any name in phytic, was fent for, at different times. As there
is nothing that I choole more to avoid than to be engag'd in controverfy, I had
long evaded it, by many and divers excufes : but I was, at length, perfuaded
to give my opinion, by the patient's wife's brother, Alexander Guarini, in
whom that ancient family, made illullrious by the eminent poet of his name,
likewile became extinct, after ibme years.
When I had heard the realonings of the contending parties, had examin'd
the urine, and had diligently examin'd the patient •, 1 anlwer'd in fuch a man-
ner, as to fhow to every body, that I did not fet light by cither of the difpu-
tants ; but gave to each his merits: yet as I ow'd more to the love of truth
than to friendfhip, I was under a neceffity of inclining to the fecond opinion.
For that chyle might, indeed, be difcharg'd by the kidnies, I laid I was
not ignorant ; provided the fecretory paifages, through thefe vifcera, are very
lax (and we muft of courfe explain lbme of thole examples which are pointed
out even in this twenty-feventh fection of the Sepulchretum (o) in this
manner.)
However, in our patient, from the fymptoms of an injury in one kidney ;
which had long preceded (and thefe pretty confiderable) and even then at-
tended the difcharge •, it feem'd that pus could not be excluded, though a
part of the chyle may join itfelf thereto. Nor did it efcape me, how foetid
a pus is, fometimes, difcharg'd from difeas'd kidnies ; yet there are examples
of pus without any fmell, not only from other parts; as when Celfus has faid
(p) " that pus is beft when it has no fmell ■" but even from the kidnies them-
lelves, and for that reafon to be taken notice of juft now.
For as to the fediment not being vifcid, that very vifcid fubftances are
lbmetimes found in the kidnies alio (as in the fame fecYion of the Sepulchre-
tum {q) ). Neverthelefs that all pus was not vifcid ; and the pus which is
difcharg'd with the urine, in a glutinous and thin ftate, I have read that the
moft experienced phyficians (V), attribute to the bladder, and not to the kid-
nies : and that Valfalva alfo, taught by diffection, had been accuftom'd to
deduce this much more feldom from the kidnies, than from the parts be-
neath.
And though we (hould pay no regard to thefe arguments, yet I could not
forget either that man, or the bifhop, whole hiftories; that have been left us
by Benediclus Silvaticus (j) and Laslius a Fonte (t) ; are as fimilar to ours, as
we can fuppofe (lb that, for this reafon, I could fcarcely believe, that thefe
hiftories, in a controverfy fo warmly agitated, had been taken notice of by
no body, before me; as I was afterwards certainly inform'd.
For in both of thefe patients, figns of a difeafe in one kidney had pre-
ceded ; and even had been attended, as in ours, with a flow fever, and a
waiting of flefh. By both of thefe patients urine was difcharg'd, the fedi-
ment of which was not foetid, nor vifcid, but inodorous and fluid ; and much
like milk. That this was pus flowing down from the kidnies, both of thefe phy-
ficians affirm'd. Others denied it ; and particularly in the cafe of the bifhop.
(c) Schol. 2. ad obf. 14. (>■) Vid. ibid. Schol. ad obf. 10 8c 15.
(/> ) De Medic. 1. 5. c. 20. n. 20. \s) (/) Vid. ibid, cit. obf. 10. cum Schol. Sc
(f) Obf. 9. §. 1. & obf. 22. §. 1. obf. 14. cum Schol.
Z Z Z 2 But
540 Book III. Of Difeafes of the Belly.
But the diffections which fhow'd the fubftance of his kidney to be con-
fum'd, or perforated, by an abfcefs, flood as a teftimony of the cafe. From
thefe things-, though I faid them more like a perfon who was making remarks,
than like one who pronounc'd upon a difeafe ; although I inculcated the diffi-
culty of judgment in determining the hidden feats and nature of difeafes •, and
though 1 did not profefs to be more learned and fagacious than the many others,
who had been confulted on the former days-, yet it was no fecret to any one
of the noble and learned men, who were prefent in great number, to which
fide my opinion was inclin'd.
Nor was the difTection of the body refus'd, foon after, when the patient died •,
by which; although it was perform'd, almoft clandestinely, by a furgeon of
no note or eminence ; it was pretty well known, neverthelefs, afterwards, in
fpite of this caution, that the kidney, of the affected fide, was found to be
half putrid, and reduc'd to a very fmall bulk.
And although this report was confirm'd by the filence of thofe, to whofe
credit it was to have it believ'd otherwife.; yet as neither I, nor any one of my
friends, was prefent at the difTection, I did not think proper to lay it down
here as certain.
45. This controverfy was at Padua. But at Venice there was formerly an-
other controverfy, in which fewer perfons were concern'd : the difpute was
whether the urine of a certain abbot had blood really mix'd with it, as it
feem'd to have, or not. The affair was almoft like that which is defcrib'd in
the fame twenty-eighth feclion of the Sepulchretum (u) ; for the blood did
not fubfide in the urine, even after being long kept.
When I was confulted, I perfuaded them to make the experiment by ap-
plying fire ; for by this means the blood might eafily coalefce, and fhow it-
felf, if it was really therein. Wherefore, by making this experiment, the
controverfy was at once put an end to.
However, in what manner the celebrated Burgmann (x) made the fame in-
quiry, by immerfing a white linen rag into the urine of this kind •, and what
Schelhamer (y) found inftead of blood, and by what means he found it ; -and
how in fome perfons blood is to be accounted for, from the haemorrhoids of
the bladder, according to Cselius Aurelianus (z) ■, although I gave an an-
fwer, at large, upon this fubject, to the celebrated Serao, who confulted me
for a noble Neapolitan patient, in regard to whofe cafe there was a great dif-
fention of phyficians •, yet I will not take up your time now in difcufTing
thefe things : but will rather exhort you to examine the authors I have com-
mended •, and to read the very learned Helwichius (*) upon the fubject of
thefe haemorrhoids.
But when you fhall read, in the fame feclion I juft now pointed out £**)»
that round, vermiform, and, bloody bodies had been difcharg'd, together with
the urine, by a certain widow who fuffcr'd a moft excruciating pain in the loins ;
you will require a more accurate examination of their fubftance, by which it
might appear that they v/ere polypous concretions, thus form'd in the ureter,
(«) Obf. 9. (z) Morbor. Chron. 1. 5. c. 4.
(x) Commerc. Litter, a. 1733. hebd. 36. (*) Eph. n. c. torn, modo cit. obf. 1 19.
(» Eph. n. c. dec. 3. a. 9. obf 8k (**) Obf. 26.
rather
Letter XLII. Article 46. 541
rather than round particles of the kidney, which had been corroded by a
cancer.
For that they were not true worms even the author of the obfervation has
acknowledged : which certainly cannot be difcharg'd together with the urine,
unlefs a pallage be open'd betwixt the bladder, or the urethra, and the intef-
tines-, as I have already mown above (a).
Wherefore, when you. come to the thirtieth obfervation of the fame fccYion,
in which it is laid that grapes, pieces of lettice, and other kinds of food, were
dilcharg'd together with the urine ; you will partly wifli for a greater cau-
tion, and a more accurate examination : and, as in one, the whole bladder is
faid to have been ulcerated, you will alio partly fufpecl, that an ulcer had
reach'd from thence into fome one, or other, of the interlines.
For it might ealily happen, that a bladder, in this ftate, fhould coalefce
with one of the neareft inteftines -, and that thus a winding finus might be
form'd, by means of a kind of ulcerous corrofion, from the one to the other.
And in this manner, we may perhaps conceive how the man of whom Young (b)
writes, difcharg'd, together with a fceculent urine, very fmall grapes, and
particles of leaves, and roots, and other things which he had eaten j and with
thefe two pills drawn out into a confiderable length.
It is certain that very fevere colic pains had preceded in the former months;
fo as to make it not altogether improbable, that fome inflam'd inteftine had
coalefc'd with the bladder, and a fmall abfeefs being made, that pus had
been difcharg'd into the cavity of both thefe vifcera, by which a fiftula of
communication might have been left open betwixt them.
For as to the urine having no difagreeable imell, when Young was call'd to
the patient ; and as to neither blood, nor pus, being difcharg'd in the ftools ;
as to there being no tenefmus •, and as to the unctuous fluid, given in the form
of a glyfter, not having ting'd the urine with its colour ; it is true that
thefe circumftances might, with good reafon, render it lefs fuppofable, with
him, that there was a communication betwixt the bladder and the rectum,
or betwixt the bladder and the colon.
Yet he would, perhaps, have thought it more probable, if he had conceiv'd
of this communication, betwixt the bladder, and fome part of the inteftine
ileum, contiguous thereto : for thofe very fevere pains which had preceded,,
although they were call'd Colic, might poflibly have been Iliac.
46. But a preternatural foramen ; which goes from the bladder to the con-
tiguous inteftinum redlum -, as it renders the explication of urine difcharg'd
by the anus very obvious ; fo it is fometimes either fo obfeure in dead bodies,,
or fo difficult to be believ'd in the living, that it is but juft poffible, and in-
deed fcarcely at all poflible, to explain this cafe, (which relates, as you fee,
to the laft but one of the fe&ions enumerated (c) ) in the fame manner, with
any degree of probability.
All thefe things that I fay I fhall illuftrate by examples. The mod ancient
of which is from Praxagoras, who relates, " that he faw a certain man, who
" had excreted his urine per anum, and had furviv'd twelve years : but whe-
(a) N. 6 & 29. I (c) Supra n. 43.
{b) Vid. apud Th. Dereham Saggio delle
Tranfaz. torn. 3. p. 2. c. 4. §. 29.
" ther
542 Book III. Of Difeafes of the Belly.
** ther more years or not 'as he himfelf had at that time departed, and had
*• not heard any thing of him afterwards) he was quite uninform'd."
This pafiage I have copied from the little book of Ruffus Ephefius, de Ve-
fica Renumque AffccHbus(d), in the fame manner as we read it in the edition of
Henricus Stephanus, of Medic <e Artis Principes ; which little book Linden, and
Mercklin (e), do not feem to have obferv'd to be extant in a Latin tran-
flation.
And thefe things I was willing you fhould know, left you fhould, per-
haps, wonder why I have not faid, as Schenck {/), and thofe who copy him,
have done, that Praxagoras had feen a certain perfon " in whom the urine
" was diicharg'd per anum for twelve years together."
Yet if he had really afTerted this, as exprefsly as he has faid that the man
furvived twelve years, there would be no great caufe for wonder j fince even
in this twenty-feventh feftion (g)y we have the hiftory of a man, who, from
his childhood to his fortieth, and even quite to his fiftieth year, " always"
diicharg'd his urine by the anus: for a lithotomift, having cut out a calculus
from him, when a boy, had fo far injur'd the bladder and inteftinum re<5tum,
that after death a paflage was found to go down from the bladder, into this
interline, " of the width of an inch."
And what the unfkilfulnefs of the operator had given rife to in this man,
feems in the man obferv'd by Praxagoras, to have been the effect of difeafe •,
for, after thofe things, Ruffus fubjoins his obfervation, that " fometimes an
" abfeefs burfts into the interline •*' although, to diffemble nothing, he fpeaks
of an abfeefs of the kidnies : but you know that Pechlinus (£), when urine
was excreted from the interlines, five or fix times every day •, in a man la-
bouring under an ifchuriaof the kidnies, and a calculus of the bladder ; left
it quite undetermin'd, whether this urine " was brought, from the bladder,
" by new, and tubulated pafTages, into the inteftinum rectum, which lies
" immediately under it ; or from the kidnies to the interlines."
However, Fcrnelius (i) fpeaks of an abfeefs of the bladder, and of the in-
teftinum rectum •, when he fays that this abfeefs has been " fometimes (ten
" to penetrate, even to the anus-, and the urine to flow out that way."
And Hildanus (£) ; when, after a long ifchuria of the bladder, and purulent
urines, he had at length feen this fluid, on the laft twenty days of the pati-
ent's life, no more diicharg'd by the penis, but by the anus •, " at one time
" by itfelf, and at another time mix'd with excrements-," found that a fmall,
and round, ulcer was carried, from the cavity of the bladder, into the in-
teftinum rectum.
Wherefore, when Horftius had related to him, that a woman ; who, in falling
from a tree, had got a laceration of the genital parts, and imprudently heal'd
up the external wound foon after, " had now difcharg'd no urine for more than
M the fpace of a fortnight," except that " a ferous humidity flow'd every day
" from the interlines, not together with the inteftinal excrements, but fepa-
(J) C. s. (g) Obf. i.
(t) Linden. Renov. vide RufFus. (£) ". id. Aft. Erud. Lipf. a. 1691. M. Maj.
(f) Obf. Med. 1. 3 ubi de Urina alien, loc. (/") Pathol. 1. 6. c. 13.
excreta, obi". 13. [k) Cent. 2. obf. 65 .
" ratelv ;
Letter XLII. Article 46.
543
" rately ;" he made no doubt to pronounce (/), " that he was firmly pcrfuad-
" ed, not only that the neck ot the bladder, and uterus, but even the in-
" teftinum rectum itlelf, had been injur'd, and perforated, by the tree.
And thus far, indeed, the explication isealy and clear ; as it had alio been
in a nobleman, if the blood which he difcharg'd from his interlines, had not,
without doubt, conceal'd the urine that was mix'd therewith : for in him the
celebrated Moratchius («/) found a calculus of the bladder, adhering to a
fungous flefh, which calculus had, at length, perforated the bladder, toge-
ther with the inteftinum rectum.
But, on the contrary, there are obfervations, in regard to which you may
hefitate; as that, for inftance, which is pointed out from the Afta Helvetica
(n), more than once, above; though with a different view. For although,
to a difcharge of bloody urine, and a dyfuria, this fymptom of making water
per anum was added, a little before the end of life ; yet the bladder fhow'd
no ulcer, and no paflage which led to the inteltine.
Add to this, an obfervation from the Sepulchretum (0), of a much longer
time. For a boy ; in whom, " through the whole fpace of ten years, the
" urine was intirely fupprefs'd, fome drops of which, though not very lim-
" pid, came forth per anum •," had his kidnies, and ureters, render'd ulllels.
by the force of difeafe : but the bladder " not at all preternaturally per-
" forated."
And indeed, where there was a great quantity of urine in the bladder (as
in him of whom Rhodius(^) fpeaks) being fupprefs'd by a caruncle of the
urethra •, this urine " flow'd, in its clear (late, through the inteftinum rec-
" turn :" but only " till, the obftruction being removed, nature return'd
" to her ufual paflage-," fo that we do not at all conceive, how it had quite
ceas'd to flow by the interline, if a paflage were really opened in a preter-
natural manner, from the bladder to that inteftine.
There was, likewife, a great quantity of urine, in the bladder of a child,
whom many take notice of from the obfervation of Benivenius (q) ; for he
had difcharg'd none for feven days ; when he at length evacuated it by the
anus. But left you fhould fuppofe, that fome remaining mark of preternatural
perforation, might poflibly be overlook'd by Rhodius, and by Benivenius ;
read over the obfervation of the celebrated Reufnerus (>), on another child.
You will, at lead, fee that there was no urine in the bladder, which could
make its way, by force, from thence into the inteftine : and yet that, on the
feventh day of the ifchuria renalis, " urine, which was fimilar to what is na-
'* turally excreted, in colour, fmell, and quantity, was difcharg'd from the
" inteftines, without any difcharge of the inteftinal feces at the fame time ;
** without any pain, or alteration :" and that three or four times a day, for
fome days together ; till all of a fudden it was again difcharg'd by the penis,
" without the leaft pain, or troublefome fymptom :" and that in this manner
the urine continued to be evacuated, in the following years.
ft) Cent. 5. obf. 47.
(m) Eph. n. c. cent. 10. obf. 56.
\n) Tom. 1.
(*) Sett. 24. obf. 6. §.. 1..
(/>) Cent. 2. obf. Med. go.
\q) De abdit. morb. caufis c. 7.
\r) Eph. n. c. cwit. 5. obf. 3.
We
544 Book III. Of Difeafes of the Belly.
We are not at liberty, therefore, to explain every excretion of urine per
anum, in that fir ft manner •, but where on account of a renal, or vefical ifchu-
ria, the blood is overloaded with the urinous particles •, and there is no fign
of any morbid paflage being open'd from the kidnies or from the bladder, to
the inteftine ; the cafe is rather to be explain'd in the following manner : I
mean that as the urine may be thrown up by vomiting; which I have already
faid (s) ; fo it alfo may be difcharg'd from the inteftines, in confequenceof the
inteftinal glands preternaturally fecreting it.
Neverthelefs, even taking this method for granted, we do not eafily con-
ceive, how the urine, when effus'd into the inteftinal tube, fhould be excret-
ed without any mixture of the inteftinal faeces, as I juft now related : which
difficulty is not even wholly remov'd, by fuppofing that method, firft fpoken
of-, as when the woman, mention'd by Horftius, did not emit the urine from
the anus, together with the inteftinal excrements, but " feparately ;" for
Hildanus had obferv'd, in his old man, that the urine fometimes flow'd "fe-
" parately, and at other times in conjunction with the fasces."
1 happen'd, fome years ago, to light on a cafe, in endeavouring to under-
ftand which ; its caufe, and the manner wherein this caufe operated ; that
difficulty, which I juft now propos'd, feem'd no more to be one of the molt
confiderable.
A young prieft, who, at his death, by reafon of his excellent natural dif-
pofition, his probity worthy of his office, and his manners which were always
exemplary, left all his acquaintance inconfolable for his lofs ; having related
to me, that he had obferv'd, a few days before, his urine to be difcharg'd per
anum ; I, who knew him to be hypochondriac, as many are who are given
to the ftudy of letters, at firft did not believe him : but, the day following
when he had taken care that the urine, which had been juft before difcharg'd
in this manner, fhould be brought to me, I then at length very clofely in-
quir'd of him, whether he had been ever affected with any diforder of the
urinary parts, or of the lower inteftine, with any pain, or uneafinefs what-
ever ? And if not long before, yet, at leaft, whether he had been troubled
with any inconveniences in making water, or going to ftool, at any time
lately ? Or was at that time troubled with any ? Whether any thing bloody, or
purulent, had been difcharg'd by either paflage ? Or was now difcharg'd ?
And other things of the like kind.
But he anfwer'd each of thefe queftions in the negative: fo that of courfe
he denied them all ; and that in fuch terms, as would have gain'd credit to a
lefs ingenuous man than him.
There had been none here, as you fee, of the caufes which I juft now took
notice of-, no exfection of a calculus, no abfeefs, no fall, no blow, no cal-
culus of the kidnies or bladder, no fuppreflion of urine in the one or
the other -, and yet the urine was difcharg'd, very often, every day, from
the bladder, and the anus, at the fame time; and this very fluid, which
generally flow'd, from the inteftine, without any of the excrements being
mix'd with it, continued to flow from thence even to the day of his death,
which was brought or> by quite a different difeafe ; that is, continued to flow
for many months, without the leaft pain or uneafinefs to him.
(j) Epift. 41. n. 5.
2 When
Letter XLIII. Article 2, 3. 54.5
When this young gentleman died, it happen'd that I was at a diftance, iii
the place of my nativity ; fo that it was not poflible for me even to alk for the
liberty of infpec~ting his body, and, perhaps, have the opportunity of learn-
ing from the dead body, what I could not furficiently understand in the liv-
ing. But thus far at pit/tnt. The next letter you may exped to be fomc-
what morter: in the mean while, farewell.
LETTER the FORTY-THIRD
Treats of Hernias.
HERNIAS, of which I am now about to treat, are divided by the mod
learned men at this time (as you very well know) into the legitimate
and fpurious ; legitimate they call thofe in which fome vifcus of the belly is
prolaps'd, and the others fpurious. I fhall follow this order. Of thofe her-
nias, therefore, the obfervations of which ftill remain in the papers of Val-
falva, thefe belong to the clafs of legitimates.
2. A man of thirty years of age, dying of a wound in his head, and hav-
ing feem'd, when living, to have three tefticles, the fcrotum and inguina
were, for this reafon, diflefted : and therein we had the following appear-
ances.
The teftes were only two in number : and thefe were in their natural ftatc.
But that which feem'd to be the third, and lay on the left fide, was a portion
of the omentum-, which had delcended into the fcrotum, wrap'd up in its
proper facculus, made up of the peritonaeum. On the right fide alfo was a
tumour, but of alefs fize : and this was made up by the appendicula vermi-
formis prolaps'd into a fimilar fac.
3. We have, here, an example of an epiplocele, and enterocele, at the fame
time; and fomething peculiar in both. The portion of the omentum, which,
in the living body, had refembled a tefticle, muft be added to the other in-
ftances, which may impofe upon us in like manner; and which formerly
created a fufpicion in me (a) ; in reading fuch a number of obfervations of
three tefticles, taken notice of by De Graaf (£), ar>d others; that there was
fome deception in many of thofe which were not confirm'd, by difTecnon,
after death.
(*) Adverf. 4. Animad.i. (£) De Viror. Organ, generat. inkrvientib.
. Vol. JI. 4 A And
546 Book HE Of Difeafes of the Belly.
And indeed, this man would certainly have increas'd their number, if the
mifbake had not been corrected by dififecYion ; as it was corrected in another,,
whofe third tefticlc, as it feem'd to be, was nothing elfe, in fact, but an hy-
datid of the bignefs of the true tefticle, and very fimilar to it in figure >
IH is afTerted by the celebrated Schreiberus (c).
However, a portion of the omentum found in the fcrotum, would" former-
ly have excited admiration, in thofe whom the celebrated Heifter (d) points
out, and confutes, by his obfervation of a double epiplocele being found
in one man, and in the fame part. »
But if the appendicula vermiformis had fallen down into the fcrotum, to-
gether with the inteftinum caecum, or even with the neighbouring part of the
colon ; although I-know that this does not fall down fo eafily as the left part
of the colon •, yet if the ligaments of the colon, on the right fide, being re-
lax'd, or broken through, as in the obfervation of Waltherus (e), the ap-
pendicula had dfffcended together with this, and<the caecum, into thefat>tum-,
the weight of thefe parts forcing the peritonaeum downwards ; it would be
more eafy to conceive how that could happen, than how this appendicle alone,,
which is fo flexible and light, fhould have come thither : unlefs it was, per-
haps, at that time greatly diftended", which it feldom is, with excrements j.
or rather, unlefs it had enter'd into a facculus form'd by the inteftinum
ileum, after the return of that inteftine into the cavity of the belly j its
length being of great afliftance thereto.
This difficulty was acknowledg'd by Lavaterus (f)y who, however, did
not fee this appendicle in the fcrotum, though he faw the inteftine colon
therein, and on the right fide too, " to the bignefs of more than a man's
** fift :" and this I have faid happens with more difficulty than on the left
iide j unlefs the hernia fhould be the confeqi>ence of a violent blow, or a fall
from a high place : an example of which kind you have in Tacconus (g).
But Mauchartus (b) affirms, " that a part q£ the colon, and even the
whole arch of this inteftine, fometimes falls down into the fcrotum-," on the
left fide •, where he fays he had feen it three times on that fide ; and " that
4' a hernia of the colon was found/' on the fame fide, by a celebrated furgeon
of Paris, " where the caecum, together with its vermiform appendix, had
fallen directly into the fcrotum."
And even the celebratsd Henfingius (/'), likewife, faw an- ofcheocele, on
the left fide, " which contain'd eight ells of the fmall inteftines, the inteftine
" caecum with the vermiform procefs, and half an ell of the inteftine colon."
And thefe things I take notice of, that you may know how far the liga-
ments, of the colon, may be relax'd, in large hernias •, fo as to fuffer this
inteftine to follow the fmall ones, when dragging downwards by their
weight ; and even the appendicula itfelf to be prolaps'd, into the left part
of the fcrotum, though together with the caecum*
(c) Nov. Comment. Acad. Sc. Imp. Petro- (f) DifTert. de Inteftinor. compref. thef. 5-
pot. torn. 3. inter phyfica obf. 6. & tab. 12. (g) DiiFert. de raris Herniis quibufdam.
£g. 2. (b) Diflert. de Hern, incarcer. c. 2.
(d) Eph. n. c. cent. 5. obf. 85. (») Diflert. de Periton. ad §. 8.
(t) Aflt, Erud. I*ipf. a. 1738. M. Jon.
But
Letter XLIII. Article 4, 5. 547
But we fhall have an opportunity below (k), likewife, to fpeak of larn;e
tnteroceles. At prctent, as I have already dclcrib'd co you obfervations, both
of the epiplocele, and enterocele, in other places, from Vallalva -, I fhall fub-
join, here, the two of this lalt hind that remain •, though they were but
I'm all.
4. A poor man, of fixty years of age, of a very bad habit, and afflicted
with a rupture, being expos'd to the cold air, and perhaps his ftrength fail-
ing him, fell down •, broke the os humeri in the middle, and (lightly
bruis'd his face. Not long after this he died.
The belly being open'd -, if you except the vafa laclea turgid with chyle,
that arofe from a large trac~l of the inteftines, without the interpofition of any
Jymphaedudls, which were feen in other places through the mefentery ; and
other appearances of the fa-me kind (which we referve to another place) no-
thing occur'd that was worthy of admiration •, befides a part of the inteftines,
which, having fallen down from the belly, into a facculus form'd of the
peritonaeum, was buried in the ufual way in the fcrotum.
When the left cavity of the thorax was laid open, the lungs immediately
.colapsM upon the entrance of the external air ; juft as they do in living ani-
mals : but this could not be obferv'd on the right fide. However both lobes
of the lungs were found.
In the brain was contain'd a little water ; and in fome places a gelatinous
concretion was obferv'd.
The mufcular parts of this carcafe were foft and flaccid: the blood was al-
moft ferous ; and had very little of its red part. But what red it had fhow'd
fome folid bodies fwimming in the ferum : yet in it were no fibres-, for when
this blood was thrown into water, there appear'd no fibrous concretion.
5. Another poor man, of about five and thirty years of age, being in like
manner expos'd to the injuries of the cold, was brought into the hofpitaJ, on
the evening of January the fifth, in the year 1690, when he was already with-
out pulfe. He complain'd, with a faultering voice, of a violent pain in his
belly : and as this was iuppos'd to be from the prokpfus of the inteftines into
the fcrotum, to which he was fubjecl:^ -they^endeavourd to replace them. In
the, morning the man died.
While the body was cut open, the flefhy parts difcharg'd a great quantity
of fiuid.
In the belly, every thing was natural ; except that a part of the inteftines
was even prolaps'd on the right fide : the peritonaeum being relax'd in the
groin and expanded, within the fcrotum, into an oblong fac, wkh a very
narrow orifice.
When the thorax was laid open, the lungs appear'd to be variegated with
black lpots, and black blood •, and on the -posterior part, where they adher'd
by membranes to the ribs, were in fome meafure infiam'd. In the right ven-
tricle of the heart was a pretty large, and in the left a fmall polypous con-
cretion,. together with grumous blood.
But as to lymphatic veftels being obvious throughout the furface of this
.heart, and of almoft all the remaining vifcera ; how diftended they were in
(i) N. 7.
4 A 7 xt>c
54_8 Book III. Of Difeafcs of the Belly.
the me-fentery, and reprefervted a feries of globules, as it were ; and other things
of" the like kind ; I fhalJ have a more convenient opportunity of fpeakino- on
thefe iubjects hereafter.
6. If you afk the reafon, why I did not give you thefe two obfervations of
Valfalva in other places, rather than here; I fhall fay, I have not given them
in other places, becauie the laft: fymptoms of the former patient are not put
down •, and the difie&ion of the head of the latter. And I have copied them
here •, to mow you that the vifcera, which Valfalva had feen to be prolaps'd,
did not fall down through a rupture of the peritonaeum, but through a re-
laxation of this membrane ; nor within a procefs of it ; but within a lacculus
made up of this membrane rclax'd.
Nor has he above (I), nor in five other obfervations, made by him, upon
hernias, which I have formerly defcrib'd to you (»*), laid down any thing
repugnant thereto ; but has even, fometimes, faid what agreed perfectly
therewith. And if you read, over again, eleven other obfervations already
given by me (n), you will find nothing repugnant to this doctrine; but a
confirmation of it.
Nor will you be furpriz'd, when you attend, not fo much to that perfuafion
which had formerly poffefs'd the minds of moft peribns, as to the obferva-
tions of thofe, who, fetting afieie this perfuafion, chofe rather to be deter-
min'd by accurate infpeclions.
Thus Arantius (<?), even in very large ruptures, faw " no folution of con-
tinuity in the peritonaeum." Thus, in that fection of the Sepulchretum,
which relates to the prefent fubjecl, that is in the twenty-ninth ; in which I
find nothing faid of Arantius ; you will read that Hildanus (p), Riolanus {q)y
Barbette (r), to whom you may add Ruyfch (j), and Benevoli (/), confirm .
the fame thing.
And, indeed, though this laft author had occafion to inveftigate thefe
things more than a hundred times, and Ruyfch not lefs often; yet both of
them affert that the peritonaeum had never been ruptur'd in hernias. But you
will fay Arantius does not deny the poflibility of its being ruptur'd ; and
Barbette, if you read him a little below («J, fpeaks in fwch a manner, as to
lead us to fuppofe that he had feen it ruptur'd, in that kind of hernia which
they now call crural.
Yet he does not exprefly fay that he had feen it. And others, befides thofe
1 have mentioned, deny their having ever feen it ; particularly Mauchartus
(x), who affirms that in five bodies which had hernias, he found the perito-
naeum " only dilated ; though the bodies were very cautioufly differed by
" him for this purpofe ; that he had never found it ruptur'd, and even that
" it had certainly never happen'd to the celebrated Parifian furgeons, whom
" he had confulted upon this rupture ; notwithflanding they have a very
" ample and frequent opportunity of inquiring into ruptures."
V. n. 2. XXXIV. n. 7.
(/) N. 2.
(:;i) Epift. II. n. 20
ft 5. XXXVIII. n. 2.
(») Ep. V. n. 19. XXI. n. 15 & 19. XXIV
n. 16. XXVI. n 37. XXXIV. n. 9
18. XLI. n. 10. XUI. n. 34.
(0) De Tumor, c. 48.
II. 15. &
(p) (q) Schol. ad obf. 19. verf. fin.
(r) Obf. 1.
(s) Adverf. Anat. dec. j. n. 9.
(/) Diflertaz. 1.
\u) Chirurg. p. 1. c. 7.
(x) Diflext. fupra ad n. 3. cit. c. 2.
And
Letter XL1II. Article 6. 54.9
And left you fiiould be in doubt, whether hi confulted them only in re-
gard to lmall hernia?, and not of large Iikewife ; he had, a little before, men-
tion'd letters fent to him from one of them, in which he lays that he had juft
then found three ells of" the final] inteflines, together with a portion of the
colon, in an M enormous" rupture.
And if you flill require larger; Henfingius, befides that which is men-
tion^ above, will give you another (_>), containing eight ells of the inteftines
and more, which lie receiv'd from the celebrated Horn melius [z) ; who, in an
infant of two years old, law " all the chylopoietic vifcera" to have fallen out
from the navel : l' the peritoneum not being ruptur'd, but only extended
and relax'd ," as Henfingius had alio ken in his observation.
And before them Mery (<?,), in the left fide of the fcrotum, of a certain old
man, which was enlarg'd to a monflrous fize, found the caecum, together with
the beginning of the colon, drag'd down thither by the fmali inteltines,
which were all of them prolaps'd in that place ; except the upper part to the
length of half a foot, by which the ftomach was Iikewife lo drawn down,
from its fituation, as to defcend, in aright line, from the diaphragm towards
the lower parts of the belly: yet a purfe or lac, made of the peritonaeum,
clofely embrae'd all this very large tumour.
Nor would I have you fay that Mery, when he before (y) gave as the
obfervation of that not lmall hernia; from a virgin -, which, befides two cir-
cumvolutions of the inteftine colon, contain'd a tract of the lmall inteftines
to the length of four feet at leaft, and had this Angularity •, on account of
which it is furprizing, that it fhould be fcarcely taken notice of, by any of
the authors, who have written of ruptures fince that time-, I mean that it ex-
tended from the left groin, quite to the middle of the thigh •, do not fay then, .
that Mery, in giving this obfervation, has not made the leaft mention of a
containing peritonaeum.
For it is natural to anfwer, that, in a hernia, the involucra of which, as
well as the fmall inteftines contain'd therein, had been putrefied by a gan-
grene, there was no opportunity far the furgeon to examine, whether the
peritonaeum had comprehended thefe parts -, as this membrane muft have been
already deftroy'd by that putrefaction, rather than ruptur'd.
And fuppofe the fame thing to be faid, in refpeel to the obfervation of Tac-
conus (c) on another virgin •, in whom, not below the ligamentum Poupartii,,
as it is call'd, but from the fame place as in the former, the inteftines having
been prolaps'd for many years, at length fell down fuddenly without the her-
nia : not fo much becaufe the peritoneum, that lay in contact: with thetnv
was ruptur'd, as half-corrupted ; and moft probably, from the fame caufe,
that had ulcerated the lower integuments of the hernia.
For you will fee, that, in a much larger rupture, fpoken of by the fame
author, whatever part of the colon and mefocolon was therein, as the de-
lineated figure clearly fhows (d), " had been inverted round about" by the
(y) N. 3. (I) Ibid. obf. 4.
(«) Ad §. ibid. cit. (c) Differt. fupra ad a. 3. cit.
\a) Mem. de l'Acad. R.. des Sc. a. 1701. (<i) Tab. 3. fig. 1.
obf. 5.
peritonaeum.
'$$o Book III. Of Difea'fes of the Belly.
peritonaeum. Other large hernias I have both read of, and feen : as tha'
which Teichmeyrus (e) reprefented as hanging down " quite to the knees ■,'
and thofe which Schacherus (f), and Meekrenius (g), have faid were " ex
*c tended beyond the knees-," and not to be too prolix, that which the cele-
brated Brebifius (h) has reprefented, as " hanging down quite to the calve
" of the legs."
But the firft has only faid (i), that a large portion of the fmall inteftines>
of the large inteftines, of the roeientery, and omentum, had been contain'd
therein : whether the fecond diffected his hernia, I do not know : the two
others cretainly did not •, nor did I difTect that which I faw in a bifliop of a
noble family •, I mean an ofcheocele alone, which was unequal in length, in-
deed, to that reprefented by Meekrenius, but not in thicknefs •, nor in this,
that the vifcera, which it contain'd, could very eafily be fore'd back into the
belly : but they could be retain'd there by no means v/hatever.
7. Is there no obfervation then, you will fay, of the peritonaeum being;
ruptur'd in herniae ? I do not contend for this-, but only that they are much
more rare than was formerly fuppos'd. And although Dionis (k) afferts j
that an omphalocele happens only if -the peritonaeum be ruptur'd -, and
that he, although he had open'd many omphaloceles, both in the liv-
ing, and dead body, could never difcover that they were inverted in-
ternally by the peritoneum -, and even that by cutting into the fkin, he had
found no membrane befides ; yet you have feen juft now (/J, how large an
omphalocele Hommelius faw comprehended in the relax'd, not ruptur'd, perito-
naeum : and you may fee, that Paul Barbette (m) had fometimes demonftrated,
in dead bodies, that although the navel, together with the fubfequent in-
teftines, ;pFOtuberated 4b as to equal the fize of a man's head, the peritonaeum
v/as neverthelefs " expanded only, and not ruptur'd " and, in like manner,
that Hottinger (n) ; in the omphalocele of a woman, which was a foot in its
diameter, or more-, having taken off the (kin, "open'd the peritonaeum,
*' which in thicknefs, and denftty, refembled the external fkin, and was
" difficult to be cut through -, having the inteftines firmly annex'd to it," as,
in a girl differed by Schulzius f<?), it had -the omentum connected to it,
in molt places.
To thefe add the obfervation of the illuftrious Haller (j>), who found the
peritonaeal fac whole in the exomphaios, as well as in other hernias. In con-
sequence of thefe obfervations you will perhaps fufpeel:, that, in fome of the
difiectior.s of Dionis, at leaft, his eyes had been deceiv'd, by the great ex-
tenuation of the peritonaeum, and its dole connexion with the common in-
teguments.
J alio read, that, in a crural hernia, a man of eminence (j) found a portion
(<•) Differt.de Exomphalo inflamm. §. n.
(f) Differt. de Mcrb. a fitu. inteit. p. n. c,
(g) Obf. Med. Chir. Pofth. c. 5.
(I) Aft. n. c. torn. 4. obf. 25.
(0 Differt. cit. §.18.
(X) Cours d'Operat. de Chir. demonftr. 2.
(/) N. 6.
(m) Seft. hac Sepulchr. 29. & obf. 1.
(«) Eph. n. c. dec. ^. a. 9. & 10. obf. 231.
(0) Ad. n. c. torn 1. obf. 226.
(/) Opufc. Pathol, obf. 29. & feq.
(j) Commerc, Litter, a. 1745. hebd, 24. n. 1.
Ctf
Letter XLIII. Article 7.. 55 c-
o5 thj omentum, colon, and ileum, " in a cavity of the ruptur'd perito-
" nreum."
Verheyen (r) ncverthelefs •, who was one of the Hrll that defcrib'd this kind
of hernia, and the manner in which patients die from an interception of it ;.
has aiferted, that it was made by the peritonaeum being " gradually dilated
4t in that part •, or, what very rarely happens, by the peritonaeum being
M ruptur'd :" and I myftlf, as I have already told you (s), have certainly
&en the facculus of it in that part •, as others have likewil'e ; and among ihefe
Mauchartus (t) •, and if you require a larger lac, Wernerus, as you read in
the lame Mauchartus (u) ; who dilated a fac in the fame part, which con-
tain'd, befide a long portion of the omentum,, a part of the inteftinum ileum,
M almolt of the length of two feet and a half."
But if we are to conlider the ofcheocele chiefly, which is not only the
more frequent hernia, but gave me occafion to enter into this difcufllon •, we
mult not difiemble, that, in the very fe&ion of the Sepulchretum (,vj, which
treats of this fubjeft, two obfervations are extant-, the one of John Rudolph
Salzmann (y), the other of Frederic Hoffmann the father (z); the former,
of whom lays, that, in. this hernia, he had demonitrated " the peritonaeum
" to be ruptur'd •," and the latter, that he had feen, " with a dilatation of
u the external coat of the peritonaeum, the internal ruptur'd, and lace-
" rated."
It may be wifh'd, in regard to thefe obfervations ; which if they are com-
par'd with the others, that are almoft innumerable-, are very rare ; that what
had been the caufe of the hernia in both of them, was not unknown to us.
For to open myfelf to you ingenuoufly, as my cuftom is, I am, in fome mea-
fure, a follower of our Fabricius (a), and even of Paulus Eginetta (b),
whole fedtary he is*
That is to fay, 1 follow them in this doclrine which they have taught us ;
that the rupture, whereof we are fpeaking, is brought about, either by a
dilatation, relaxation, or rupture of the peritonaeum; and in this likewife ;
that when it happens from a rupture, " the interline is fuddenly, and at once,
*' pufh'd down in the beginning ; and that from violent caufes only : and
" there is a very large tumour •" or, as others tranflate the words of Paulus -y
** k is of an immenle magnitude."
Yet in this I cannot follow them, that a rupture is always to be acknow-
ledge, even where all thefe figns have come together.
For my aflent to this doctrine is witheld, not only by the obfervations be-
fore advane'd, of large ruptures* and thole which violent caufes (fuch as a
fall from a high place, or the like) had produe'd, or increas'd, without a
rupture of the peritonaeum -, but alfo by reafon •, which, as Mauchartus (r)
fhows, by no means forbids us to fuppofe what caufes there might be, either
from the original formation, or afterwards, of fo great a propenfity to dila-
(r) Anat. corp. hum. 1. i. tr. 2. C. 7. (-z.) Obf. 14. §. 3.
(s) Epifl. 34. n. 15. (a) Pentateuch. 1. i.e. 24. & de Chirurg,
(1) Diflert. fupra ad n. 3. cit. c. 4.111 fin. Operat. ubi de Inteft. Hernia.
{u) Diflert. de Epiplo-Ente-rocele Crurali. (6) De Re Medica I. 6. c. 65.
(x) 29. 1. 3. \() Difl'ert. fupra ad n. 3. cit. c 2.
to) Obi. 3.
lation*
•552 Book III. Of Difeafes of the Belly.
tation, in this membrane •, that the circumftance, to which there was a pre-
vious difpofuion long before, might feem to be brought about of a fudden.
And this being the ftate of the matter •, I commend Fabricius fo much the
more •, for afferting that this membrane id) " was either dilated, or ruptur'd :
" but that, for the mod parr, it was dilated •" the more I perceive there may
be room for his affertion : not only when hernise are form'd " gradually and
•" flowly," as he fuppos'd •, but even when they are form'd of a fudden.
Yet if you now produce the observation of Saltzmann (?), on the ftable-
keeper, who labour'd under a bubonocele before, and in whom, by the kick
of a horfe in his belly, " the whole bulk of the interlines fell down into the
" fcrotum in one moment as it were ;" fo that this part feem'd almoft like
another belly in magnitude (the abdomen being, in the mean time, extreme-
ly collaps'd) and confirm it by another obfervation which he takes notice of
from Petit ; who, in a fimilar cafe, which happen'd from the fame caufe,
found the peritonjeal fac open'd •, I fliall without difficulty allow, that, in
both of the examples, the peritonaeum had been ruptur'd : nor did I ever
perfuade rayfeif that this membrane had fo much ftrength, and firmnefs, as
not to allow of its being broken through by blows of this kind, or other vio-
lent caufes ; which, for that reaibn, I was willing to fuppofe had been ap-
plied, in thole two obfervations of Saltzmann, and Hoffmann, which I faid
are extant in the Sepulchretum.
I do not, however, fuppofe this to happen from every caufe that is call'd
violent, nor at all times •, and I even fuppofe it to happen but feldom. A-
mong triefe < ?v'.cs, for inflance, I fee that riding on horfeback is now rec*
kon'd .:■>)> : nor do I deny, if It be too frequently us'd, that it may
cauJc, and inc reafe, hernias, from an extenfion of trie peritonaeum ; as I bear
in mind the example of Marcus Servilius, of whom Livy (f) relates, that
while he was haranguing the people •, and mowing the fears of wounds, which
he had receiv'd in the forepart of his body, in the caufe of his country •, " the
" parts, which fhould have been conceal'd, being accidentally uncover'd, a
" tumour of the groin had rais'd a laugh in thofe who flood near him ■" and
that he then went on to fay, " and this tumour alio, which is the object of
" your laughter, I have got by fitting, night and day, on horfeback : nor am
" I more afhani'd, or forry, for this tumour, than I am for thefe fears-, fince
'* it was never any impediment to me, in the adminiftration of the common*
tc wealth, either at home or abroad."
And he had been conful, and mailer of the horfe, and had fought three and
twenty times with the enemy, in pitch'd battles. His rupture therefore,
whether it was a bubonocele, or ; as the Latins made ufe of the word
inguim ; an ofcheocele •, that is, whether it was an inguinal, or a fcrotal hernia;
it was not, I fay, one of thefe large ones, which are accounted for from a
rupture of the peritonaeum: for it muft, on this fuppofition, have been a
hindrance to him, in performing thofe offices which he had perform'd •, as
befides that one, whom I took notice of above (g), from Meekrenius, I haw
(./) De Or-erat loco indicate (f) Ki.t. I. ±e,
-ir) Differt. de Hern. \ t.lic. thef. zi. (g) N. 6.
read
Letter XLIII. Article 8. 553
iv.ui of no perfon, whofe alertnefs of aclion was not, for the moft part, much
obltructed by an obftacle and burden of tins nature.
Riding for a long time together therefore ; and that at the fulled fpeed the
horfe can be rous'd CO by fpurring •, if repeated very frequently, may, I be-
!:e\v, be ibmetimes capable of rupturing the peritonaeum : and at the fame
time, 1 cannot help fuppoling, that every exertion of the body, in leaping,
or dancing ; that every fall from a high place ; thai every blow •, that every
ftrong exertion of the voice-, finally, that every draining, and holding of the
breath ; which may relax the peritoneum i is not equal to the talk of break-
ing through this membrane.
And thus far of this controverfy. Now let us go on to the hernial fac-
culus itfclf.
8. It was formerly believ'd that the hernial facculus was the procefs of the
peritonaeum dilated ; I mean that procefs which they fuppos'd to receive the
f] ( made veflels, from the cavity of the abdomen ; and, after having accom-
panied them, to expand itfelf, at length, into the tunica vaginalis : and this
they continued to believe even after Fernelius (b) had fo clearly fhown that
the peritoneum was not perforated for the egrefs of thefe veflels.
But truth was at length fuperior to error, by the confent and diligence of
more accurate diflfecters : with whom you will plainly perceive Valfalva's ob-
fervations, upon hernias, and mine, to agree ; by reading over again thofe
which are defcrib'd pretty much at large.
For fee in the thirty-fourth letter (i), how exprefly he denies the facculus
to be made up of the procefs of the peritoneum, which accompanies the
fpermatic veflels ; as they formerly believ'd : and he even fays that it lay up-
on this procefs, at the fuperior part.
Wherefore, in the firfl of the three obfervations, which I have defcrib'd
to you above (k) ; when he fays that the omentum was contain'd within its
" proper " fac, made up of the peritoneum, without doubt he made ufe of
this word proper, that we might immediately diftinguifh it from that procefs,
which was alio common to the veflels.
And I have often plac'd the matter in fo clear a light, as to make an in-
terpretation needlefs. Thus in the fifth letter (/), I have faid that the facculus
was very near to the vagina, or fheath, of the fpermatic veflels; of whatever
nature this vagina may be fuppos'd.
Thus I have faid in the twenty-firft letter (»*)» that the facculus was in the
beginning, and progrefs, of it, on the internal fide of thefe veflels ; betwixt
the membrane that covers thefe veflels, and that coat which is join'd to the
cremafrer mufcle. Thus in the twenty-fourth letter, I have faid (n), that
the facculus defcended under this very coat, and on the fame internal fide of
the veflels ; and that near the orifice of this fac, thefe veflels went to, not the
cavity of the belly, but the peritoneum : but in another (<?) you will find
that it was near to the external fide of thefe veflels.
(-&) Phyfiol. I. i.e. 7. {m) N. 15.
(i) N. 5. (n) N. 9.
(*) N. 2. (0) N. 18.
(/) N. ,9.
Vol. II. 4 B There
554 Book III. Of Difeafes of the Belly.
There are, indeed, fome differences, betwixt my obfervations, and thofe
of others, and even thofe of Valfalva himfelf. For he, as I have faid, faw
the facculus lying upon the veffels, in a dead body, on the fuperior part ;
that is, if you fuppofe the body erect, at the anterior part ; which fome very
learned men fay to be " perpetually" obferv'd.
But I have met with it, fometimes, on the internal, and fometimes on the
external, fide of thofe veffels. And there is one perfon, if I rightly conceive,
who has feen the cremafter mufcle lying betwixt the facculus, and the vef-
fels ; which I fuppofe to be much more rare : at leaft I have found it other-
wife, as I have already faid.
Thefe differences of fituation, however, although very neceffary for fur-
geons to attend to •, do not, by any means, prevent me from agreeing with Val-
ialva, and both of us with the moft accurate obfervers •, in that which is its
principal circumftance : I mean that the hernial facculus is one thing, and the
procefs of the peritonaeum another: although, at this time, there is no fmall
controverfy amongft anatomifts, in regard to acknowledging this procefs.
For as to Fernelius denying that it was made up of the internal coat of the
peritonaeum, and afferting it to confift, at leaft, of the other external coat •, how
can they admit of this fuppofition, who do not acknowledge any fuch exter-
nal coat ? In which number however, I do not fufficiently know, why this
learned man feems to place Swammerdam, from his notes on the Prodromus
Hornii ; Ruyfch from the ninety-eighth obfervation ; and Juftus Schraderus
from the fifth obfervation of the fecond Decuria.
But they who, in fact, confider the cellular membrane as forming this
coat-, as they do not deny that this at leaft defcends into the fcrotum with the
fpermatic veffels, grant us enough, in the mean time, to fet afide the con-
troverfy, and, at leaft, to mark out this involucrum, in which thefe veffels
are contain'd, and which proceeds from the peritonaeum, under the term va-
gina, in refpect of thefe veffels, and under the term procefs, in refpect to
the peritonaeum.
Nor was Valfalva himfelf, in my opinion, very diftant from an explication
of this kind ; when he us'd the expreffion procefs of the peritonaeum (p). For
although he did not always teach me the fame thing, upon this fubject, when
I was a young man •, yet I very well remember, when he, finally, deliver'd
himfelf thus : that neither the tendon of the external oblique mufcle, nor the
peritonaeum, in that part through which the fpermatic veffels defcend from
the abdomen, properly fo call'd, towards the fcrotum ; I fay, that neither
this tendon is perforated, into the form of a real ring, nor the peritonaeum is
hollow'd out into a fheath •, both of which circumftances were generally be-
liev'd i but only fome filaments were fent down, here and there, over thofe
veffels : nor was there any other connexion betwixt the peritonaeum, and the
tunica vaginalis.
From whence you alio underftand, that he did not confider that procefs
as a kind of continued canal ; which, having firft clofely embrae'd thofe vef-
fels, at length expanded itfelf into the tunica vaginalis. Nor indeed could
he be ignorant that the cavity of this coat does not raife itfelf up much
above the tefticle-, as this not only appears from infpection of the parts ana-
(p) Epift. 34. n.5.
tomically,
Letter XLIII. Article 9. 555
tomically, but even Swammerdam in his Miraculum Natura exprefly ud-
monifhes us, that this coat " does not extend itfelf much beyond the tef-
" tides."
And Blafius, having follow'd this opinion (q), has made, from thence,
fuch deductions as I fhall take notice of below (r), when I treat of the hydro-
cele: in the mean while you may fee them in the Sepulchretum (j). And
as thefe deductions are transfer'd thither, fo it would have been alio proper,
to transfer what has been obferv'd by Swammerdam, in the place refer'd to ;
and what Juftus Schraderus (/) has obferv'd together with him, of the pro-
cefs of the peritoneum •, if there be fuch a one ; and the hernial facculus,
being quite different things.
"What is it then, you will fay, that Bofcus relates in the Sepulchretum (u) ;
" that the vagina of the teilicle, made by the peritonaeum," was demon-
ftrated, by him, in a child labouring under an enterocele, " to be fo dilated
" in its origin, and quite to the fundus, and termination of it, that two
" fingers eafily were introduced into it ?"
I fliould fuppofe it probable, that by fome very rare accident the lower
part of the hernial fac was burft through on one hand ; and on the other,
that the upper part of the tunica vaginalis was ruptur'd alfo ; by which
means they had coalefc'd into one tube : or that, as Mery (#) fufpedled in a
certain fingular obfervation of his, fimilar to the prefent, in this boy the tunica
vaginalis, as is the cafe in moll quadrupeds, had happen'd to be quite per-
vious, from the cavity of the belly to the tefticle •, I mould fuppofe it pro-
bable, I lay, if Bofcus did not affirm that he had feen the fame thing " fre-
quently," and did not think " it was eafily to be feen by all."
Since therefore, it has not only not happen'd to others, to find it thus,
but to me likewife ; and fince it has even been found quite otherwife ; it re-
mains to fufpect that this author, and thofe who were prefent, were led into
an error ; perhaps by the extenuation, and adhefion, of both the coats to
each other, and at the fame time to the tefticle, in fo great a degree, that
this might feem to be quite protuberating within the hernial fac, in the '
body in queftion.
9. But it becomes us, ftiil more, to beware of other blunders in the living
body •, left we imagine an inteftine, or the omentum, to be prolaps'd out of
the cavity of the belly, without reafon.
There are many things which render incautious perfons liable to this error;
as, for inftance, the tefticle, when about to defcend into the fcrotum very
late, as fometimes happens ; for it raifes up the groin, yet cannot eafily be
miftaken for a bubonocele ; except by thofe who, not imitating Brechtfeld (y),
neglect previoufly to examine the fcrotum, efpecially in children, and obferve
the tefticle to be deficient therein : as for inftance alfo, one of.the inguinal
glands, increas'd into that form which I defcrib'd in the thirty-firft let-
ter (z), in the butcher ± or many of them together with coagulated ferum,
(f) Obf. Anat. in Horn, ubide Telle. (x) Mem. de l'Acad. R. des Sc. a. 1701.
(r) N. 32. obf. 3.
(i) Scft. hac. 29. obf. 2. (_>•) Vid. apud Bartholin. Aft. Med. Hafn.
(/) Dec. 2. Obf. Anat. Med. 5. vol. 1. obf. 106.
(v) Sea. cit. obf. 5. (jb) N. 19.
4 B 2 fuch
556 Book III. Of Difeafes of the Belly.
fuch as Reifelius found (a): and finally, as other appearances ; in order ro
prevent being impos'd upon by which, all the other circumftances mult be
accurately inquir'd after, and confider'd.
I was at Venice, when a woman lent for furgeons, and phyficians •, and
among thefe Santorini •, in order to alcertain the nature of the tumour, which
was prominent in one of her groins ; as fhe fear'd left it mould be a bubono-
cele, for this reafon, that it had appear'd fuddenly, as fhe was ftrainin^ to
difcharge the harden'd excrements from the inteftines.
All fignsof a hernia were abfent ; except that immediately upon applyino-
their hands to that part, the woman difcharg'd wind by eructation.
Santorini, obferving the phyficians to be in doubt, merely on this account,
fmil'd ; and faid to them, and whatever part of my body you touch, you will
hear eructations immediately come on. They inftantly made the experi-
ment, and found it to be as he had faid.
When Santorini related thefe things to me, and to fome more friends,
others vvonder'd at it as an unheard of circumftance •, but I faid, it is extra-
ordinary indeed, yet not unheard of. For I remember to have read, in Etmul-
ler (£), " that what Bartholin in the Atta Medica Hafnienjia, page one hundred
" and ninety-nine, and Rhodius in the fifty-fecond obfervation of the fecond
" chapter, have obferv'd, of continual eructations being excited, by external
" friction, in any part of the body whatever, is very extraordinary."
Yet left the fame thing happen to you, which happen'dto my friends ; if you
mould choofe, in fo very rare a cafe, to turn to the authors themfelves, point-
ed out by Etmuller ; in Rhodius you will certainly wifh for a more happy
memory in the reference ; but in Bartholin you will fee there is a typoora-
phical error-, page one hundred and ninety-nine being put for a hundred and
ninety-four-, and will really find the obfervation of a man, " who from a
" flight friction of any part of the body, immediately fell into fo enormous
" an eructation, that he did not ceafe to eructate before the friction ceas'd."
But that obfervation is the hundred and fecond of the firft part, of the firft
volume, of the acts already quoted •> Brechtfeld, phylician to the king's mo-
ther, being the author.
10. There are other appearances alfo, which are not equally rare to be met
with, nor yet very frequent ; and thefe not only in the groins, but alfo at the
navel, and the fcrotum -, which may fometimes create a difficulty, to phy-
ficians, in diftinguifhing ruptures, and fometimes deceive them.
Thus I remember, that, in regard to a certain moft ferene prince ; who,
among other things, was alfo fubject to flatus, and hypochondriac diftentions
of the belly, it was related to me by his phyficians, who were in other re-
flects excellent men, that a little above the navel of this great perfonage, and
on the left fide, an epiplocele had appear'd : in examining of which place,
although I perceiv'd a kind of lax and flight prominence, of a circular cir-
cumference, the diameter of which was equal to three inches at leaft ; yet as
I oerceiv'd nothing unequal to be under it, and the prince himfelf did not
give fuch anfwers to my interrogations as confirm'd the judgment of the
phyficians ■, I chofe rather towithold my alfent : nor was I forry for it, when,
(«) Eph. n. c dec. 2. a. 7. obf. 12. (£) Prax. 1. i,f, 4. c.2. in Frognof.
4 after
Letter XLIII. Article 10.
557
tftet Tome months, the patient having died from quite a different caule, I was
inform'd, by'the account of the dificttion being fern to me, that the deception
refer'dto by the celebrated llcillcr(r) hail happen'd ; I mean that there was
TOthing under the fkin, befides rat di i tending; the cells of the membrana adi-
pofa, that was pufh'd outwards, not by the peritonaeum, which was by no
means lax, but only by realbn of the very great quantity of fat, which was
prominent in that part : vt which kind of tumours 1 lhall write to you here-
after (<!).
But that this kind of tumour fometimes refembles bubonoceles, appears
from the obfervation of Schulzius (*), in a man, in whom it was fo much
the more eaiy to be deceiv'd, becaufe, as lie was of a very lean habit, nobody
would have thought of lb great a quantity of fat being join'd to the fper-
matic veflels. *
And although another whom Petfchius (f) difTected was very fat ; yet the
deception was very natural for this realbn ; becaufe the fat, collected in the
cellular fubltance of the peritonaeum, was carried out " through the rings to
" the fcrotum •" not on both fides, but in the right fide only 5 in fuch a quan-
tity, that there feem'd to be an ofcheocele in that part.
Moreover, in the fcrotum-, where, in other refpedts, frequently, when
there is a complex kind of hernia, the one is obicur'd by the other, as when
a great quantity of water, lying round about, prevents us from diflinguifh-
ing the included omentum, or inteftine, or both, with our fingers •, it may
befides fometimes happen, that we may fuppofe a fimple kind to be complex ;
or at leaft fuppofe it to be what it is not.
For who ; in that obfervation of Vefalius, for inftance (which you find
copied in the Sepulchretum alfo (g) ) when he had obferv'd the fcrotum to be
fo large and heavy •, who, I fay, would have thought it to have arifen from
a part of the omentum only, which had fallen down thither, increas'd to
fuch a magnitude, as " to weigh four or five pounds ?"
Or how few ; to come to a more recent example ; would have been able
readily to avoid the deception (into which Gunzius himfelf {b) confeffes, with
a very commendable ingenuoufnefs, that he had fallen) fo as to think ; when
they faw a tumour narrow, and conftricled at the groin, but in the fcrotum
large, and extenfive, with a rotundity of figure •, that no part of the intefline3
was there : but only that the omentum, which was found to be grown very
thick, and folded back at its lower part, was contain'd therein ?
Or who, finally, is there •, to whom the obfervations (that are not often to
be met with) of thofe excellent men, whom I commendedtto you in the thirty-
fourth letter (i), are unknown ; that, when he fees this fymptom to be want-
ing, and not to be added to mod of the others, of an intercepted inteftine;
I mean that the paflage of the inteftines is obitructed ; dare affirm that fome
part of thefe is intercepted, either at the navel, or at the groin, or in the
fcrotum •, as others have found, or at the upper part of the thigh, as I have
found (k) : and on the other hand, although no excrements pafs, that, never-
(c) Inft. Chir. p. ;. f. 5
(A) Epiic. 50. n 24.
(f) Aft. n. c. torn. 1. obf. 225.
(f) Syllog. anat. obf. §. $j.
c. 120. n. 1.
(^) Se£t. hac 29. obf. 15. §. 3.
(h) Proluf. de Entero-Epiplocel.
(i) N. 16. 17.
(k) Ibid. n. 15.
;h clefs,
558 Book III. Of Diieafes of the Belly.
thelefs, nothing but fome part of the paries of the inteftine is intercepted, as
I have formerly feen in the groin (I); and very lately, even below this, that
very experienc'd furgeon Anthony Benevoli (m).
But perhaps I fhall alio have occafion, hereafter, to point out blunders,
which may eafily happen, in the diagnofis of hernias.
1 1. For now fomewhat mud be faid, of thofe things that relate to the re-
placing of the inteftine prolaps'd into the fcrotum ; in order to fatisfy you in
your enquiry, whether Valfalva was then averfe to the ufe of glyfters ? This
gentleman took the utmoft care, as his duty was, and as you may perceive
even from the opinion which he wrote, that nothing fhould obftruct the re-
placing of the inteftine ; and even that every thing fhould, as far as pofiible,
give way to their return into the belly.
Therefore, when the hernia was become fomewhat foften'd -, which he
brought about by the application of balls of raw filk, moiften'd in hot water,
in which chamomile flowers, melilot flowers, linfeed, and fasnugreekfeed,
had been boil'd, and renewing them every fourth hour (for this was then the
cuftom at Bologna, though the balls of raw-lilk were more frequently moif-
ten'd with the lixivium j here they ufe fponges dip'd into the dregs of olive
oil made hot) he then endeavour'd, with a gentle hand, to replace the intef-
tines; and this at a time when the ftomach had been empty as long as pof-
fible, without any other fituation of body being requir'd in the patient, than
that which, as it is cuftomary, he prefcrib'd from the very beginning : and
obferving that inftant of time in particular, in impelling the inteftine^ when
the patient, by his orders, produe'd his expiration to a considerable length.
Butprevioufly to this he had order'd blood-lettings : efpecially where there
was too great a quantity of blood •, at which time he alfo recommended the other
ufual remedies ; among which I understand even glyfters ; and at the fame time
he always prefcrib'd great fparingnefs, in the ufe of food and drink, and the
avoiding of every thing that could generate flatus : and befides thefe things
he ordered an emollient broth morning and evening ; and oil, frefh-drawn
from fweet-almonds, to be taken through the day, in the quantity of a fpoon-
ful at a time, fo as not to confume more than two ounces every day.
After he had replac'd the inteftines, he took care the patient mould keep
the fame pofture of body •, and that the return of the hernia fhould be pre-
vented by a proper bandage ; to which a piece of foft fponge, three inches
long, as many broad, and one thick, was faften'd. But when, after having
often attempted to replace the prolaps'd parts, at proper intervals, he did not
fucceed in the attenfpt •, and, in the mean while, no other violent fymptoms
oblig'd him to change his defign ; rather than create an inflammation, by
teazing the part to no purpofe, he then order'd the patient to avoid all
thefe things which I have mention'd above, and to keep up to the fame mol-
lifying regimen, which I faid may be made ufe of both internally and ex-
ternally i but with thofe particularly the pofture of lying down fo often in-
culcated •, I mean that the pubes fhould be higher than the other part of the
belly : for by this means he faid that nature often perform'd the cure of
herfelf.
(I) Ibid. n. 18. (m) DueRelaz. Chirurg. Relaz. 2.
Thus
Letter XLIII. Article 12. 559
Thus I have contracted the whole of his Con/ilium into a fhort compafs for
you ; not becaufe the greater part of the methods prefcrib'd, are not com-
mon to all practitioners ; but even for this very reafon, that they are lb: and
this in order to convince you, that •, as they all agree in this one intention,
which is indicated by reafon itlelf, that there may be nothing in the belly to
refift the return of the inteftines, but that every thing may give way ; it does
not appear, why formerly, and even in our time, fome were fo averl'e to the
ule of glyfters : by means of which whatever can be brought down this way,
may be evacuated from the inteftines, without any irritation.
For as to their faying that glyfters go down to the fcrotum, and, by rea-
fon of their weight, deprefs •* the inteftines more, and increafe the hernia;"
this perhaps would have place, where the part of the colon, neareft to the
rectum, had fallen into the fcrotum •, or where, by the periftaltic motion be-
ing already inverted, every thing was hurried away, from the rectum, into the
other inteftines.
And neither of thefe circumftances can be afierted by them : that is, the
firft: cannot, becaufe they confefs " that the colon feldom goes out" into the
fcrotum •, nor the fecond, becaufe when " the molt violent fymptoms have
" already come on ;" then, at length, even they themfelves permit us to have
rccourfe to glyfters.
12. But when there is a neceflity of making ufe of the knife, as Valfalva,
whofe method in particular you defire to know, has left nothing in writing,
relative to the manner in which it ought to be us'd ; there is no reafon why I
fhould detain you, on fuch fubjects as are fufficiently treated of, by other
authors.
I will, however, juft touch upon a few things, which may be confirm'd by
his diflections, or mine. And firft, in regard to thofe things which moft ob-
ftruct the return of the inteftines ; a narrow nets at the orifice of the facculus,
a hardnefs of it, and a connexion of the prolaps'd parts to the facculus, or
to one another; that thefe appearances have occur'd to us fometimes, certain
pafiages of the fifth (n), twenty-firft (<?), and twenty-fourth letters (p), and:
even of this very letter (q), will (how.
You will, afterwards, attend to the changes which we find in the parts j
either the parts within the facculus, or thofe that lye near it. Among thofe,
in particular, that is moft worthy of obfervation which Valfalva law, as you
have it in the fecond letter (r); that is to fay the teftis ; feemingly from the
effect of an old epiplocele, in a young man, who had, in other refpects, en-
joy'd firm health, and was about two and twenty years of age •, chang'd uni-
verfally into a membranous body.
You will read, in the Sepulchretum (j), of " very fmall, comprefs'd, and
" yellowilh, teftes, fcarcely equal to the bignefs of a nutmeg," being found
with a hernia ; but a large hernia, and not made up of the omentum only,
but alfo of no fmall portion of the mefentery, and the inteftinum ileum ; and
that of twenty years {landing, and in an old man of feventy.
(«) N. 2. ' (?) N. 5.
(«) N. 15. (r) N. 20.
(p) N. 5. 9. 18. . (s) Se&. hac 29. obf. 13.
2 He
560 Book III. Of Difeafes of the Belly.
He likewife was an old man, whofe tefticle neareft to the hernia, I
found to be lei's than the other, and that in a confiderable degree, being, at
the fame time, of a brown colour internally, inclining to red ; as I faid in
the twenty-fourth letter (/). Yet that hernia was an enterocele ; and by rea-
son of inflammation fatal : fo that it is evident, to what caufe this colour, of
the teftis, is to be referr'd.
Thefe two obfervations then, mow that the magnitude of the tefticles is
fome times diminifh'd, by reafon of the parts being prolaps'd into the fcro-
tum : and the firfl demonftrates that the very ftrudture is fometimes univer-
fally chang'd.
From which, as you may perceive that what fome have pronoune'd, is not
always true •, I mean, ".that to be afraid of ftenlity, or impotency, from rup-
" tures, is futile and abfurd ," fo you may alfo conjecture, that men afflicted
with hernias, fometimes, become impotent ; not only becaufe " the veflels,"
as Boerhaave (u) has taught, " grow to the fac ;" but alfo becaufe, befides
the veflels, the teftes themfelves are prefs'd upon by the weight, not only of
the prolaps'd inteftine, but of the mefentery likewife ; and fometimes by that
of the omentum alone : and this for a long time together.
13. And what changes fometimes happen, to the parts which fall into the
hernial fac; and how eafily many, and confiderable, errors, in the art of
healing, may be produe'd by the neglect of this animadverfion ; Gunzius (x)
has very learnedly admonifh'd, where he confeflfes his own deception, in
refpedt of the omentum. To whofe obfervation of the omentum being be-
come very thick, and fat, you will join the obfervations that were made be-
fore, of Sprogelius (j), in a living man, and of Mauchartus (z), in a body-
after death.
And that you may not fuppofe the omentum alone to be chang'd ; you
will alfo add that which is related by Lavaterus (a), " of the inteftines being
" foft like wet paper ;" to that there is lefs occafion to be furpriz'd, if a
fuppuration in particular, or a gangrene, coming on, they are broken
through, and pour out what liquid fasces they contain, into the cavity of the
hernia: and fo this hernia either refemble another fpecies of hernias, or an
abfeefs •, as the obfervations of the celebrated Heifter (b) in living, and in
dead bodies, jointly demonftrate.
But to infill upon the changes which Valfalva, and I, have feen to hap-
pen in the prolaps'd parts; you will learn them from the twenty-fourth
letter.
Nor do I (peak only of changes in the inteftines ; which you will find, in
feveral places, to have been either inflam'd, or black and gangrenous, in
confequence of the interception ; but in the omentum likewife, and mefen-
tery. For you will read that the omentum was doubled up, and form'd into
a round body (c), which I could not learn the nature of, but by cutting into
its fubftance.
(r) N. 16. (a) Diflert. ad eund. n. 3. cit. n. 23.
\u) Pradett. adlnftit. §. 641. (b) Diflert. de Hernia Incarcer. §. 10 &
(x) Proluf. fupra ad n. 10. cit. 15.
(y) Eph. n. c. cent. 7. obf. 70. (c) N. 9.
£z) Diflert. fupra ad n. 3. cit. c. 2. in fine.
And
Letter XLIII. Article 13. 561
And that a portion of the mefentery appear'd, to Valfalv.i, to be (d) al-
moft flefhy, you will learn in the fame place. That portion, I fay, which, it'
the double inteftine defcends pretty low, mud, of comic, follow it within
the facculus ; for by reafon of the fat, with whjch it is furnilh'd in great
quantity, it can be much more eafily relax'd, than ruptur'd. And it. is lup-
pos'd never to be more relax'd than in hernia?.
14 This foftnefs, and laxity, of the mefentery," fays Wharton (<;), "isfrc-
" qucntly found in an inteflinal hernia. For it is fometimes lb far relax'd,
" as to permit the inteftine attach'd to it •, which it ought naturally to con
" fine within its own circumference -t to fall down into the fcrotum."
But he whom I frequently, and defervedly, commend to you, Benevoli
(/), has undertaken to (how, in a differtation which certainly well defervea
to be read, that a laxity of the mefentery takes place always, not to fa;,
frequently, in thefe hernia? ; and that even from thence they rirft have their
origin. To which fuppofition relates the obfervation, that is given in thi.;.
lection of the Sepulchretum (g\ from Hoffmann the father •, who cries up
the virtues of his magnetic plaifter, in drawing up the inteftines from her*
nia?, when applied to the loins.
But if the virtues, and efficacies, of this plaifter are really fo great, as to
penetrate through the thicknefs of the loins •, which it is very difficult to con-
ceive ; and even as they muft, of courfe, be, to pervade the lumbar verte-
bra?, and corroborate the mefentery •, I am furpriz'd that his fon has made
no mention -, which, as far as I remember, he has not done •, of this plaifter,
in any one of the feveral places, where he treats of hernias, and their cure.
However, as Etmuller affirms (b), " that he had feen furprizing effects" from
this plaifter, I will, if you pleafe, leave the merits of it entirely undetermin'd
in this place i efpecially as, if a perfon, afflicted with a rupture, fhould be
willing to apply corroborants, and aftringents, to the loins ; in that part
where the mefentery is connected thereto •, Benevoli has no objection to fuch
an application.
But I do not believe that Benevoli had feen what was written, many years
ago, by the celebrated Roftius (i) ; when in a man, afflicted with a rupture,
he had found the mefentery lax ; " I mean, that it was mod probable intef-
*' tinal hernia? particularly requir'd this laxity •, fince the inteftines are firmly
" connected to the mefentery, and therefore cannot be remov'd from their
M fituation, unlefs the mefentery, from fome violent caufe or other, firft
" give way :" nor do I believe, that the differtation of Benevoli had come
to the hands of the celebrated Brendelius (k), when he, ftill more confirm'd
the fame opinion.
For to the obfervation of Roftius, and the others of Benevoli •, and that
particularly which was made on the taylor, the greater part of whofe large
enterocele was not now made up of the inteftines, but of an expansion of the
mefentery ; you have fome from Brendelius, principally, that may be added :
fince he aflerts, that, as often as ever he inquir'd into this circumftance, he
(d) N. 5. (h) Prax. I. I. f. 12. c. r.
(e) Adenogr. e. 11. (/) Aft. n. c. torn. 2. obf. 178.
(f) Diflenazion 1. (k) Progr. dc Heraiar. Natalibus.
(g) Obf. 14. |. 3.
Vol. II. a C had
562 Book III. Of Difcafes of the Belly.
had found the mefentery to have been, from the very original, " always im-
" moderately relax'd, and, in a manner, diftended -," and even in a porter,
that the peritonaeum itfelf was there disjoin'd from the large veflels, and that
the mefentery in him, and in another, " was diftended incredibly." fo that in
the fecond, at Ieaft, in the places, where it generally is very fmall " it was of
" the extent of three or four fpans."
And left you fhould imagine thefe things to happen from the weight of
the prolaps*d inteftines, as well as the pains of the loins ; Roftius admo-
nifhes us, that thofe who contract hernias, from the motion of riding on horfe-
back, " generally feel a painful tenfion, firft of all,, about the loins •, a pretty
clear proof," fays he, of the mefentery, which is fix'd there, " being affected
" with a tenfion, or diffraction, of the fibres."
And indeed, I have obferv'd that the attentive phyfician Riedlinus (*),
though he did not find, among authors, the figns of an enterocele coming
on, had given hints long before, from a certain obfervation of his own, from
what fymptoms we may fufpect it : and, in the number of thefe, had, in
she firft place, fet down pains of the loins.
But it is certain, you will fay, that in an ofcheocele, a very eminent ana-
tomift found the mefentery, which being, ** like a fmall rope, tenfe, and
" hard, had defcended together with the inteftines." Shall we fay then, that
there was any thing lax, or weak, in a mefentery of that kind, and impute
the origin of the hernia thereto ?
I will afk of you, however, whether you fuppofe it to have been fo tenfe,
and hard, at the time of its coming down ; and that it was not poffible, for
the fame thing to have happen'd to it afterwards, which I faid I had feen,
even in the omentum itfelf, when intercepted ; or that which Mauchartus,
and Sprogelius, have remark'd in the fame part, in their obfervations " of
" its being very hard and almoft fcirrhous," as already quoted ?
And I will moreover afk you, if it could, poflibly, have defcended, with
fome ells of the fmall inteftines, into a very large hernia, unlefs it had been
extremely lax ? For it is certain that, when it is in a natural ftate, it cannot
reach fo low downwards.
But do not be forward to fuppofe, that I fay thefe things for the fake of
defending the opinion of Bcnevoli, rather than what appears to me to be
truth-, efpecially as I attribute fome of thefe effects, as he himfelf likewife
did, to the laxity of the peritonaeum alfo, and the rings-, in conjunction with
Roftius and Brendelius ; and not all of them to the laxity of the me-
fentery.
14. From what I have hinted, and evenftill more from thofe parts of the let-
ter, to which I have referr'd, you will call to mind what you have heard from
me, at other times, in regard to obfervations made by us, on the bubonocele,
oicheocele, omphalocele, and merocele ; and of the parts that have been con-
tain*d in thefe fevcral ruptures: fo that there is no occafion to repeat them
here.
I am rather difpos'd to add fomething, in relation to thefe two herniae laft-
mention'd.
In the omphalocele, though the omentum feems, as it has been found
by us, and by others, to be neceffarily included from its fituation ; yet
(*) Eph. n. c. dec. 3. a. 9 & 10. obf. 15a.
Ro-
Letter XLIII. Article 14. 563
Roftius (**) fhows, by his own obfervation, and by thole of Arnauld, ant!
Petk, that it is frequently not included •, but chat a part of the inteftine
jejunum, or colon, occurs without it; where he alio obfervea other things,
in regard to vomiting coming on fooner, or later, according to the different
inteftine that is intercepted •, and not always difcharging the fame kind oi
matter •, which remarks will afford you pleafurc as well as profit in pe-
ril fin g.
But if you fhould happen to wifli for difle&ions of thole who were affected
with the meroccle, to add to the Sepulchretum, you will find them in the
oblervations which I have pointed out above (/) ; and in the papers of Gen-
teMws (m) befides •, but particularly in the work of that author who publUh'd
a difiertation upon this diforder, which is commonly call'd the hernia femora-
lis, or cruralis •, I mean the celebrated Daniel Koch (»).
And perhaps in looking over thefe authors, and thofe obfervations, and
remarking that the greater part of the hernias of this kind, was found to be
in men-, it may difpleafe you to find it afiferted, by a phyfician in other re-
fpects learned, " that men do not readily become fubjedt " to this diforder :
although, to confefs the truth, it has never yet happen'd to me to fee it, ex-
cept in women.
Some herniae, that are very rare-, whether you confider the place in which
they are form'd, or the parts that fall down ; neither Vallalva, nor I havefeen.
Among thefe, is that which happens where the obturator nerve, as they
call it, comes forth, together with the veffels of the fame name ; which nerve,
the fame learned phyfician, to whom I juft now refer'd, has call'd, for I know
not what reafon, " the pofterior crural " under which term others fignify the
nerve that is the thickeft of all. Of this hernia, however, confult thofe au-
thors that are quoted in the Commercium Litterarium (0), and by Plat-
ner (p).
Much more rare than this, is that which is accurately defcrib'd by Chrif-
topher Henry Papen (q) ; as he had found it in a body after death : for it was
very fimilar to a large oblong bladder, beginning from the right fide of the
anus, and including within itafac continued from the peritoneum, the fmall
inteftines, with the mefentery extremely elongated, and the beginning of the
colon : and as thefe vifcera had fallen down through the fiflure call'd lncifura
Ifchio.dico-fo.cra ; as he to whom the obfervation was fent, that is the cele-
brated Haller, rightly judges; we will rather referve the name of Hernia
Dorfalis for that other, if it does at any time appear, which Paul Barbette (r),
as the author very well knew, and as you alfo have it in the Sepulchretum (j),
had referr'd to in thefe words : " experience has taught me, that the peri-
" tonaeum may be ruptur'd even in the pofterior part, towards the back, and
" there produce a hernia."
But in the number of thofe herniae that are rare, when confider'd in re-
fpect to the parts which prolapfe, is the cyftocele.
(**) Obf. fupra adn. 13. cit. (0) A. 1743. hebd. 47. n. 1.
(1) N. 7. \p) Diflert. de Hydrocel. §. 2. not. ;-.
(m) Eph. n. c. cent. 7 & 8. in Append, ubi (q) Epift. de ilupenda Hernia Dorfali.
Conlt. Epid. Hungar. a. 1 7 1 3 . in Septembr. \r) Chirurg. p. 1. c. 8. verf. fin.
(a) C. 2. §. 5. (0 Seft. hac 29. obf. 8.
4. C 2 r\nd
564 Book III. Of Difeafes of the Belly.
And as in writing to you upon this hernia, in a former letter (/), I made
mention of it in fuch a manner, as to fhow that it happen'd to women in
ibme analogous manner ; that is to fay, the bladder not falling out through
the groin ; I will now add, that in thefe patients, it does alfo fometimes pro-
laple at the groin : as two obfervations of Benevoli (#), whom I have often
quoted, teach us.
And as in one of thefe he mows, how many years before this diforder had
begun ; it appears from hence, that this hernia is not the effect, of the original
conformation, as Mery (x) thought : efpecially, fince of fo many others,
which 1 then pointed out from men, there was not one (as far as I remem-
ber) the beginning of which feems to have appear'd from the original confti-
tution of the body.
How can it happen then, you will fay, that the connexions, and ligaments,
of the bladder, the peritonaeum, and the mufcles of the abdomen, fuffer it
to be pufh'd out through one or other of the groins ?
Read, I befeech you, the differtation of that ingenious man Jo. Salzmann
(y), where to thofe things which Petit (z) ; he himfelf alio being an obferver
of" an hernia of this kind ; had produe'd, in order to diminifh thefe difficul-
ties, he moreover adds other things which tend to make you think lefs of
♦hem j and of that one in particular which was drawn from the refiftance of
the peritonaeum, that is mention'd on this occafion by many, who do not at-
tend to this circumftance ; that the bladder is not in the peritonaeum, but
under it.
Yet if it fhould not be poffible to remove all thefe difficulties, this hcrniaj
neverthelefs, cannot, for that reafon, be denied to exift ; as not only the fign
that has been already pointed out, and is very evidently pathognomonic, has
confirm'd its exiftence, but even infpecYions of bodies after death, then
pointed out in like manner; as thofe of our Jo. Dominic Sala in Bartholin,
and of Ruyfch himfelf : fo that it is furprizing there fhould have been any
one, fo late as in the year 17 13, who look'd upon this diforder as new j and
though fome faid it was firft obferv'd by one, and fome by another, yet all
contended that it was firft obferv'd about that time : although, even former-
ly, Phterus, who is mention'd by me in the fame place, as foon as ever the
urine flow'd from the diftended, and wounded fcrotum, in an ifchuria of the
bladder, knew the diforder to be this hernia of which we are fpeaking, and
particularly defcrib'd it.
And left you fhould be inclined to believe, that this contention had relat-
ed, in part at leaft, to the hernia of the female bladder, when prolaps'd tO'
gether with the vaginae ; call to mind that an obfervation of this kind had
been publifh'd by Pyerus fd), fome years before that of Ruyfch, and con-
firm'd by a diffedtion, which you have even in the Sepulchretum (b).
This was afterwards follow'd by other obfervations taken from the dead,
bodies ; and particularly by thofe of the very celebrated Baffius (c)t and
(/) Epift. 41. n. 12. (x) Hiftoir. de l'Acad. R. des Sc. a. 1717.
(«) Ofiervaz. 25. 26. {a) Eph. n. c. dec. 2. a. 1. obf. 84.
(xJMem. de l'Acad. R. des Sea. 1713. obf. 3. (i) L. 3. f. 31. in additam, obf. 5.
(_y) De Hernia Vefics Urinar. thef. 22. & (t) Dec. 3. Obf. Anat. Cbir. 2.
feq.
Burr
Letter XLIII. Article 14. 565
Burgrafius (</). Mery, who htd very clearly confirm'd the defccnt of tin-
male bladder, into the fcrotum, by diffection in the dead body (e), found a
hernia of the female bladder in a living woman only, in the perinaeum (/) :
a very rare inltance indeed.
Thefe things, however, I do not fay with a view to repeat any thing, but
to illuftratc, in a brief manner, what has been hinted at ellewhere ; and to
compleat whatever belongs to the hiftory of hernia: of the bladder.
One ftill more rare than the cyftocele is the hyfterocele, when laid open
by diffe&ion. Yet befides that obfervation of it, which is transferr'd into
the Sepulchretum (g), two were publifh'd in the epiftle of Doringius to Hilda-
nus •, in reading the former of which, that is taken from the institutions of
Senertus, you will obferve this alio-, that in lb large a hernia, and one that
had its origin from a blow, the peritonaeum, as far as Senertus could judge
by the fight, had remain'd entire.
But who could doubt, even without diffection, that the uterus was really
contain'd in three other hernia: -, two of which are mention'd as " hanging
** down beyond the middle of the thighs," and a third " quite to the knees -,"'
by Carolus Sponius (i>), and Frederic Ruyfch (/) -, when he reads that the
foetufTes were happily brought forth, the hernia being " lifted up " by the
midwife, which Ruyfch himfelf faw ; or fuppofes that after the foetus was
brought forth, the hernia fubfided very much, and remain'd without its for-
mer internal motions : which marks, or others of that kind, Sponius muft,
of courfe, have attended to.
Add to thefe, the hernias which are form'd by the prolapfus of other
vifcera •, as for inftance, by the fpleen, which was found by the fame Ruyfch'
(&), in the dilated peritonaeum •, and by the ftomach •, two obfervations of
which kind, although not confirm'd by diflection, yet by no means obfeure,
are given us by Peter Kirfchbaum (/) : and finally by the liver ; which was
found in a hernia, on diffection, by Solomon Reiielius (m).
Thefe, and other hernias of this kind, if you, confider the vifcus that they
contain, you will name from thence •, as Reifelius does his hepatocele. But
if you have a view to that part of the abdomen* in which they happen, you
will name them from thence.
For if you mould call any one hernia ventris^ or ventralis, as many do now ;
you would rightly call it to be fure : but as you would point out nothing
more than a genus, which is too extenfive in its fignification, you might ftill
be afk'd about the particular fituation •, which you could not have been, if
you had at firft convey'd this idea.
And, in determining the feat of ruptures, do not imagine that you mould
do wrong, if you were to call that umbilical, which is not in the very ring:
of the navel ; in which place I fcarcely remember to have feen the prolaps'd
part, in any other patients than in one very tender male infant.
(d) Aft. n. c. torn. 4. obf. 126. (i) Adverf. Dec. 2. n. 9.
(e) Mem. cit. obf. 1. {k) Ibid.
(f) Obf. 2. (/) Diflert. de Hernia Ventric. §. 3. Hift.i,
(g) L. 3. f. 38. in Append, obf. 2» & 2.
(b) ' Apud Lavater. DifTert. de Inteft. Com- (m) Eph. n. c. dec. 3.^7. obf. 6.
preff. Thef. 4-3.
Lefc
566 Book III. Of Difeafes of the Belly.
Let it be fufficient for you that it is near the navel •, for you will have com-
panions, and thofe not defpicable ones neither, who will even underftand it
in the fame light ; and do at prefent ufe it in this fenfe : but there may be
as many different fituations, as there are regions of the abdomen.
Thus, for inftance, Lavaterus (n) faw a hernia in the right hypochon-
drium, under the fpurious ribs, which intercepted a part of the inteftinum
jejunum. Thus other hernias happen in other regions ; all which he fuccef-
fively names, or refers to in order ; fo that I cannot help being furpriz'd at
Rolfinc (o), for denying that hernias happen in the hypochondria, or the
pubes ; his words are, " for I know of no example that can be given, where-
" in thefe parts were ever feen to be thus affected."
For, although other examples, probably, did not occur to his memory at
that time ; notwithstanding they are now fo frequently to be met with, that
even I myfelf have twice examin'd (p) hernias at the pubes, by diffe&ion;
yet, at leaft, he ought not to have forgotten the pafTage of Hippocrates (q)t
which his interpreter, Francifcus Vallefius (r), and Hieronymus Mercurialis
(j), had confider'd •, I could wifh with fufficient fuccefs, and in every part :
" Ruptures which happen about the pubes, are, for the moft part, without
" any immediate danger, but thole which are a little above the navel, in the
** right fide, are painful, are attended with anxiety, and produce a ftercora-
" ceous vomiting ; as happen'd even to Pfitaccus."
This pafTage you will fee produc'd, in a differtation (/) which has beer*
learnedly and fkilfully written, by that celebrated man B. Ignat. le ChaufTe.
15. It now follows, that, as we have treated of true hernias, we fhould go
on to fpeak of the fpurious likewife; that is, of thofe in which there is no
prolaplus of any part from the belly.
Thefe are the hydrocele, the pneumatocele, hasmatocele, cirfocele, fteato-
cele, farcocele, and fpermatocele. But although thefe are many in number,
I neverthelefs fhall not dwell long upon them all. For you have already had
all the obfervations relative thereto, when examin'd by dhTection, from Val-
falva ; and moft of them from me.
16. A hydrocele I have twice defcrib'd, from the obfervation of Valfal-
va, in the twentieth letter (u). In reading of which over again, you will
readily perceive him to be the imitator of Malpighi (x). For both of them
fearch into the nature of the fluid in the hydrocele, by the help of evapora-
tion. Both of them prefs'd out fome fmall drops from the tunica vaginalis ;
and Valfalva moreover from the albuginea. From which, as he has left in
writing on another occafion, even when every thing was in a very natural
ftate, he faw little drops burfting forth, in a parallel Order, upon comprefTing
the tefticle.
So alio Malpighi had feen drops " burft forth from regular orifices," in the
tunica vaginalis : " by repeating the compreffions frequently, others were
(«) Diflert. cit. thef. 5. (s) Adnot. in eum libr. n. 6.
(0) Diatrib. de Entcrocele, c. 3. §. 4. (t) De Hernia Ventrali ad §. 10.
(p) Epift. 5. n. 19. & epift. 34. n. 1 1. s (u) N. 24 & 26.
{q) Dc Morb. Popul. 1. 2. f. i. verf. fin. (x) Epift. de Strud. Gland.
i>-) Comment in earn fed. n.19.
*■'' fqueez'd
Letter XLIII. " Article 17.
567
" fqueez'd out; and among theft aim oft: innumerable drops, fomc were
M large."
Wherefore, it was the opinion of both theft authors, that a little moifture
is fecreted by the tunica vaginalis, in a natural ftate j and that this moifture
ferves to lubricate the furfaces of that membrane, and the albuginea, by ly -
ing betwixt them like a kind of dew, and preventing their coalition •, io
that by this means the tefticle may be kept loft, and lit for performing in
office: and if this humour is collected together by dileafe, that the h,
cele is then form'd.
Yet there are fome perfons at this time, who fay that there is no ca-
vity here, and no water in a natural ftate ; notwithstanding they are not ig-
norant of Velalius having neverthelefs taught us (y), that the tunica vaginalis
is internally " cover'd over with a kind of aqueous humour •," which, after
him, was alio ihen by others at different times-, and of Boerhaave (z) having
added, that " having cut operf the tunica vaginalis in a horfe, a great deal
" of water could be prefs'd out."
But theft things I do not hint at for this reafon, that I think this the only
way, in which the origin of a hydrocele may be explain'd. And even when I
reflect upon all my obfervations with attention, I find none which does not
fhow, that thole hydroceles of the tunica vaginalis, which I have examin'd,
had deriv'd their origin from hydatids being ruptur'd there.
And this will appear to you in the lame light, I believe, when you obferve
that in each of them, fome hydatids were ftill remaining ; either in a per-
fect and entire ftate, or half-lacerated ; or that fome traces of them were
vifible.
But before I begin to give, or take notice of, thefe obfervations, it may
be of ufe to know, that hydatids are fometimes found within this cavity ; even
when no hydrocele was yet begun : and if thefe hydatids burft afunder, and
firft pour out the water they contain; and after that go on to fecrete ftill more
and more-, there is not the leaft doubt but they mud produce a hydrocele.
And in the fourth letter to you (#), I have made mention of two hyda-
tids in that part; both of which were lying upon the teft.es, one upon each ;
both of them large ; yet in fuch proportion that the left was the largeft ;
being loofe and free on every fide, and containing fuch a humour, as I did
not fee concrete when put upon the fire ; but leaving a certain thin pellicle
behind it, evaporate away -, juft as it has fometimes happen'd to Malpighi (/-),,
and to Valfalva (c), in examining the water of the hydrocele in the fame man
ner. But let us go on to thofe obfervations.
17. An old foldier, who was gibbous, being brought into this hofpital,
and dying there very foon after; it was impoffible to learn what diforders he
had been afflicted with, and what had been the occafion of his death, fo much
from the relation of the man himfelf while living ; or from the obfervatior-
of the phyficians -, as from his dilTection after death.
The oody, fuch as it was, was carried to the college, where I was te-achr
(y) De Corp. Hum. Fabr. 1. 5. c. 13.
(s) Praeleft. ad Into. §.641.
(a) N. 30.
\l>) (f) Locis paulo ante indicatis.
mg
5 68 Book III. Of Difeafes of the Belly.
ing anatomy, in that very cold feafon which I have fpoken of already (d) •,
that is in the month of February of the year 1740.
The belly fhow'd no preternatural appearance, if you except what relates
to the icrotum •, of which I mall fpeak hereafter j and fomething bony in
the iliac arteries.
In both cavities of the thorax was a confiderable quantity of water •, in
the pericardium not a little ; being every where concreted by the froft. Yet
the lungs ; except that one lobe was connected with the pleura, for a confi-
derable extent, and, at the firft divifion of the bronchia, they had one
bronchial gland, amongft a great number, of a very confiderable fize ; fhow'd
no great marks of difeafe : nor did the legs and feet fhow even any flight be-
ginning; of an oedematous tumour.
To the internal furrace of the pericardium, which was thicken'd, and to the
external furface of the heart, adher'd, here and there, a kind of thick and
almoft puriform matter : and this I fuppos'd to be the more vifcid and poly-
pous part of that water, which, as I have already faid, had been frozen within
the pericardium.
When this matter was pull'd away from the heart, the fat, with which it was
cover'd, every where, in great quantity, feem'd to be lefs eroded, as it were,
in feveral places. But I did not fuffer myfelf to be deceiv'd by this appear-
ance, as I bore in mind thole things which I had formerly obferv'd ; as I have
fufficiently demonftrated to you, when I wrote the twenty-firft (e)> and
twenty -firth (f) letter to you : where I take notice, in a curibry manner, even
of this foldier.
The heart itlelf feem'd to be larger than it naturally is, and the branches
of velTels to be wider j particularly thofe branches of the great artery that
are call'd fubclavians and carotids. But the valves of the aorta were evidently
enlarg'd, and the trunk itfelf, in that part which lies neareft to the heart.
Nor were beginning olTifications wanting here and there, in that part; and
betwixt the internal coats were even fmall bony fcales ; which occur'd (till
more frequently beyond this tract, and particularly within the orifices of
the left carotids ; that is to fay, of the internal, and external -, and in the
brachial artery alio, at the flexure of the elbow, and beneath it.
The feven or eight upper vertebras, of the thorax, were lb plac'd, that the
fpine being there curv'd, and infle&ed to one fide, as many of the ribs, of the
fame fide, were prominent backwards, and made a gibbofity.
The cranium, as better heads were procur'd in the mean while, was not
open'd.
It remains that I now fubjoin what appearances I found by cutting into the
fcrotum a few days after. This part was found on the right fide, both inter-
nally and externally ; on the left fide it was tumid. Under the thicken'd
coats therefore, I mean the erythroides and vaginalis, and within the enlarg'd
cavity of this latter coat, I found water of a brown colour inclining to yellow ;
half-concreted by the froft ; in fome confiderable, but not very great, quan-
tity.
When I examin'd the teftis, which feem'd rather to be extended in its length,
(</) Epift. 13. n. 5 (O N. 2. (f) N. 24.
5 than
Letter XLIII. Article 18, 19, 20, 21. 569
than to be thicken'd •, and the epididymis, which certainly was longer than
natural ; I obferv'd a kind or' fmall fimbria to be hanging from the albu-
ginea, where it invcited the teilicle, very near to the |ar 51 r jdobe of the epi-
didymia : and this fimbria I judg'd was to be confider'd as the relics ot a
ruptur'd hydatid ■, elpecially as, not far from "this, I percciv'd an entire hy-
datid protuberating from the lame coat.
1S. One of thole male bodies, the principal parts of which I difi'e&ed at
Padua, in the latter end" of November of the year 171S, had one fide of
the fcrotum fomewhat tumid.
Betwixt the tunica vaginalis and albuginea, of that fide, I found a water
of the colour of urine-, but not in great quantity : the albuginea was unequal
with very fmall tubercles : and I was led to fuppoie thefe to have been the
remains of hydatids •, which had burft afunder, and difcharg'd their water •,
by feeing fome hydatids, in the fame coat, which were not yet quite burft
atunder: and thefe hydatids I demonftrated to thofe who were p relent.
19. There was another male body, among thofe that I directed at Bo-
logna, in the ipring of the year 1703, which had a hydrocele of a moderate
fize, on one fide in like manner.
Thofe two fame coats contain'd, betwixt them, a fluid fimilar to water in
which frefti meat has been wafh'd. And from the larger globe of the epi-
didymis, a fmall hydatid was pendulous, by means of a (lender and fhort
filament. Through this filament pafs'd a fanguiferous veiTel of a much
fmaller fize.
20. That in thefe three examples there was no great quantity of water, wc
may conjecture is to be, perhaps, accounted for from hence ; that neither all
the hydatids had burft afunder intirely •, and they which had burft were
fmall ; nor had they continued to difcharge a fluid long after their rupture.
But the laft example will bring to your mind thofe things which I hinted
in the thirty-eighth letter (g)t of the origin of hydatids, pendulous, in like
manner, from the teftes of women. And as many things, that I have there
faid upon hydatids (£), are illuftrated by thofe that I fay here ; fo, on the other
hand, thofe, if you read them over again, will contribute to the illuftration
of thefe.
Wherefore I fhall here fuperfede the examples of thofe things which hap*
pen to hydatids, in other parts in like manner, as well as in the tefticles of
men. In which you may now, with me, obferve the very fame feries of
changes, from the obfervations before given.
21. And firft I would have you call to mind, that, in the butcher (whofe
direction I gave you in the twenty-firft letter (i) ) when within both the
tunica vaginales was a yellowilh water ; the hydatids, which, I fuppofe, had
pour'd out this fluid not long before, appear'd to me like veficles made up
of thick parietes •, as if contracted into themfelves, and therefore, almoft
folid, and of a flefhy colour : each of them being pendulous from the albu-
ginea, near to the larger globe of the epididymis, by means of a peduncle ;
and juft in the fame place, on the right and on the left fide.
And from hence •, which I obferve by the way ; you will naturally con-
(g) N. 38, in fin. (/;) N. 35. & feq. (/) N. 19.
Vol. II. 4 D ceive,
570 Book III. Of Difeafes of the Belly.
ceive, what was that flefhy gland, as it were, which Vallifneri (k) has taken
notice of, as hanging by its proper (talk, from the female ovary : and from
fo frequent an obiervation of hydatids, either in a fix'd or a pendulous ftate ;
both in the ovaries of women, and the tefticles of men •, you will take a new
argument of the fimilitude that there is betwixt both thefe parts, if we con •
fider the fubject in this general way. But from a veficle that was almoil
/olid, let us now go on to a tubercle, or corpulcle, which was already quite
folid.
22. A herdfman died in this hofpital, after the middle of January in the
year 1743. As I cannot certainly fay what diforders he had been chiefly fub-
ject to, and by what diforders he was carried off, you will yourfelf conjecture
them from the preternatural appearances that I found ; when the parts which
belong to the belly, and the thorax, were difiected in the college.
The thorax ; for with this cavity I choofe at prefent to begin ; had the
lungs clofely connected to the pleura, though in other refpects found : the
heart was enlarg'd : and the great artery was not without a fmall bony fcale,
where it began to defcend : the carotids were much thicker than ufual, and
the internal jugular veins were extremely wide-, efpecially that on the right
fide •, which, to appearance, being fill'd more with air than with blood, was
equal to the thicknefs of a man's thumb.
When the belly was open'd, our eyes were attracted by the lower part of
the inteftine colon, on the left fide, which was dilated with flatus ; and, for
that reafon, fo forc'd out of its ufual fituation, that the curv'd part of
this inteftine was, in almoft its whole extent, plac'd tranfverfly in the um-
bilical region ; thereby laying great room for errors, if any fhould, from the
feat of pains in that part, have fuppos'd that not the colon, but the intef-
tine jejunum, was the part affected thereby.
The flomach was very large, and very lax. In this cavity were contain'd
many worms : the internal coat was wanting, for fome fpace, on the left fide,.
and on the pofterior furface of the fundus •, and in that part which is very
near to the pylorus, the beginning of a gangrene appear'd.
Where the omentum adher'd to the flomach •, in which place, in general,
you certainly fee very fmall glands of the lymphatic kind, if you fee any at
all ; occur'd fome of the magnitude of a fmall bean. The fpleen was fix
inches in width, two or three inches thick, a fpan and a half long, and of a
very lax and foft fubftance.
Yet the liver was not bigger than it naturally is, and internally, in one
half of it, was colourlefs -, whereas the other half was of a dilute yellow : and
from this vifcus, were fent forth three or four biliary, ducts, than which I
never remember to have feen any wider; and in particular than one which
would almoft have admitted the point of my little ringer.
No caufe of this dilatation appear'd at that time : but I fhould, perhaps,
have corjectur'd that a calculus had formerly ftuck in, the trunk, in which all
thefe branches, according to cuftom, join'd -, if this trunk, which was in 1
other refpects large, had been, itfelf, alfb, of that width, which was requir'd
in proportion.
In the cyft was a bile of a brown colour ; but this bile, neverthelefs, gave
(i) Iftor. della Generaz. p. 2. c. 5. n. 21.
5 a tinge
Letter XLIII. Article 23, 24. 571
a tinge of a deep yellow: notwithstanding a great quantity flow'd out of it,
when cut afunder, a kind of tough fxces ltill remain d, iimilar to thofe which
fubfide at the bottom of wine.
One of the iliac arteries was, in fome places, tortuous, in the fame man-
ner that we fee the fplenic to be : and the furfaces of both theft veflcls, inter-
nally, were almoft rugous, and of a brown colour •, except where one of
theie furfaces fhow'd in one particular part, a little whiiilh fubflance, of the
hardnefs of a ligament, not yet bony.
The bulb of the corpus fpongiofum urethras, which is generally black
internally, and externally, from the ftagnation of bloo.l therein, contain'd
none at all in this fubjecl •, which I do not remember to have feen elfewhere ;
fo that the cellules of it, which were open enough in other refpecls, were only
half-red, and of a rlefhy colour.
One of the teftes was in its natural (late, except that, betwixt itfelf and
the epididymis, it had a thin flap of fat interpos'd •, whereas the man wat
not at all fat in other refpects.
But the other was furrounded with fuch a quantity of water, of a very yel-
low colour, that no fibres any more appear'd through the tunica cry-
throides ; that is, in conlequence of this being diftended by the tunica vagi-
nalis ; which was not only diftended itfelf alio, but extended its cavity to the
height of three inches above the upper part of the telticle •, though always
decreasing in its width, the higher it reach'd : the teftis was indeed found ; but
fo produe'd in length, that it feem'd to have caus'd a diltraftion in the fibres
of the epididymis, which was connected thereto.
Near to the larger globe of this epididymis, a roundifli corpufcle was
prominent from the albuginea, that feem'd to be made up of the fubftancc
of this coat. The fafciculus of the fpermatic vefiels was much thicken'd in-
deed ; but was made up, in the greater part of it, of a yellowifh fat.
23. In this, and other obfervations, which I am about to point out, or
produce, do not be furpriz'd, that, tho' there was a great quantity of water,
or at lead not a little, within the tunica vaginalis ; yet there was often but
one corpufcle, and that not large.
For it might be the remains of a large hydatid, one which had, for a
considerable time, difcharg'd water-, although it had at length, for a long
time paft, contracted itfelf into that ftate of fmallnefs : and if there had been
any fimilar corpufcles befides, they might, fometimes, have intirely vanilh'd
away.
Having given you this admonition, I will not only call back to your me-
mory, the old man of whom I wrote in the fortieth letter (J) ; in whofe tunica
vaginalis, on one fide, was a turbid water, in" confiderable quantity, and a
roundiih corpufcle, of the fame colour with the albuginca, was prominent,
near to the larger globe of the epididymis ; but I will furthermore add, on
this occafion, two other hiftories ; one of which confirms that there may be,
at the fame time, many corpufcles, and the other mows, by what means they
may fometimes efcape the eyes of the diflecter.
24. An old man, whofe occupation had been that of hufbandry, was car-
ried off", in this hofpital, by a dropfy of the thorax, at the time I was about to
.-(/) N. 22. vid. &epiil. 64. n. 7.
4 D 2 begin
572 Book III. Of Difeafes of the Belly.
begin the bufinefs of teaching anatomy publicly •, that is in the month of Ja-
nuary, in the year 1 73 1 . His body was therefore brought into the theatre, and
diffected in the proper order-, notwithftanding I mall here alfo, as I did in
the herdfman, defcribe thofe parts in the laft place, that were firft examin'd.
After the water was exhaufted from the thorax, the lungs were found to be
flaccid, and much difeas'd. But not to the heart.
When the abdomen was laid open, befides thofe things relating to the appen-
dicula vermiformis, the valvula Bauhini, the liver, and the fpleen •, which are
fuifkiently explain'd in the fourteenth anatomical epiftle(/w/), and which there
is no occafion to repeat here ; the trunk of the great artery was found to be
unequal here and there, in feveral parts of its internal furface ; being either
become quite bony, or inclining thereto.
And of the branches of the cseliac, that which runs up on the fundus of the
flomach, was univerfally diftorted in a furprizing manner (which I never faw
before) as if into the form of crifp'd, or frizzled hair, frequently inflecting
itfelf backwards.
The urinary bladder being contracted greatly into itfelf, thicken'd, and
indurated, gave a refiftance to the air which was blown into it ; and could
not be dilated thereby. Internally it was ting'd, round about, with a bloody
rednefs ; as if from inflammation •, but principally at the lower part : where,
from the middle of the very circumference of the orifice of the urethra, from
the internal, and at the fame time, pofterior furface, a protuberance was
prominent within the bladder, of the fhape and magnitude of a middle-fiz'd
grape.
And this protuberance, although itfelf was there red, from the diftention
of the fanguiferous veflels, was neverthelefs made up, internally, of a
white and compact fubftance, into which the proftate gland was evidently
produc'd.
Finally, one of the teftes was fmall, and contain'd within a great quantity
of water-, which had, in part, concreted into icy lamellae, by the force of
the cold. This water was contain'd within the tunica vaginalis. And from
the albuginea ; both where it inverted the tefticle, near to the larger Mobc
of the epididymus, and where, producing itfelf, it cover'd this very globe;
from each place, I fay, a corpufcle was prominent ; fo that the two were very
near to each other : and thefe were made up of a denfe and hard fubftance.
25. A man, who had fallen from a high place, about the beginning of
April in the year 1740, broke the bones of his head and thorax -, as I fhall
write in a future letter («). But at prefent, as he labour'd under a hydro-
cele on both fides of the fcrotum, I will take this occafion to tell you what I
faw in both places.
The tunica vaginchs contain'd a limpid water : but not both in an equal
quantity. For the cavity of one was either nothing, or but little, extended
beyond its natural bounds : yet the cavity of the other was produc'd quite to
the upper part of the os pubis ; being gradually more contracted indeed,
but Hill pretty wide, and interrupted with no cells, or fibres whatever.
Both the teflicles were found : although that which was contain'd in the
(»») N. 62. («) Epift. 52. n. 34.
larger
Letter XLIII. Article 26, 27. 573
larger cavity, was confiderably larger than the other. The (mailer had a fmall
tubercle, of the lame colour with the albuginea, and fix'd to it, as if made
up thereof, but not hard. The larger fhowrd nothing of this kind, But as 1
happen'd to obferve that, while the water which had fur rounded it, was dil-
charg'd, a little body, of fome kind or other, had come out therewith, I
found, by looking into this water, a corpufcle of the bignefs of a fmall grape-,
and of the fhape alio : except that this little body, inclining fomewhat to the
oval figure, had, in the middle of one extremity, a fliort and (lender neck
as it were ; fo as to refemble a very fmall bottle, or if you pleaie a grape ft ill
furnifh'd with a ftalk : and that of the fame fubftance with the grape.
And indeed this corpufcle leem'd to have adher'd, to fome part, by this
its neck, or ftalk •, and being fhaken off, from fome cauie or other, to have
fallen into the water, where it might eafily have efcap'd obiervation. The
fubftance whereof it confifted, internally, and externally, was white, denfe and
compact •, if you except a very fmall part of an irregular figure, which oc-
cupied the middle place, and leem'd to be a kind of nucleus. For this part
was yellowifli, and almoft of a bony hardnefs •, whereas every other part, when
prefs'd betwixt the fingers, gave way in fome meafure.
26. It does not elcape me, what you may principally object againft thofe
things, which I feem to myfelf to be at liberty to conjecture, from the ob-
fervations that I have given you •, and this even in dependance upon fome of
my own obfervations, which you have receiv'd at other times. For I very
well remember, that in the twenty-fourth (o), the forty-firft (p), and the for-
ty-fecond (q), letters, I have defcrib'd tefticles, wherefrom a roundifh cor-
pufcle was prominent, or even pendulous, which to me was a proof of an
hydatid having been ruptur'd •, whereas the tunica vaginalis, neverthelefs,
fometimes contain'd a little water only, fcarcely any at other times, and even
none at all at fome times.
And againft thefe obfervations, I am fo far from being willing to make
ufe of any fubterfuge, that I am, moreover, willing to add others of the fame
kind to them •, and then, at length, declare, why none of them is any infu-
perable objection to my conjectures.
27. Another man died in the hofpital, a few days after we had difiected
that body, of which I fpoke laft : he had been brought thither, under the
moft violent fymptoms of an incarcerated hernia, as it is call'd; and too late
for any affiftance to be given him.
As I was ablent, our Mediavia difiected the body : who, on the very fame
day, and foon after, related what he had feen -, and, at the fame time, took
care that fome parts, which I defir'd to examine myfelf, fhould be brought
to me. Take firft then what he related to me, that you may add it to what
has been laid above of the enterocele ; and after that I will tell you what I ob-
ferv'd in refpect of the hydrocele.
The facculus of the hernia, being confin'd beneath the cremafter mufcle,
and the tunica erythroides, annex'd thereto, had the fpermatic vefiels, and
the tefticle, behind it. In the facculus, the duplicated portion of the inteftine
ileum was flightly connected thereto ; in fuch a manner that it could be fe-
(«) N. 16. (/) N- i3. (?) N. 11.
parated
574 Book HI. Of Difeafes of the fielly.
parated with the fingers : yet could it not be thruft back into the belly, by
reafon of the narrownefs of the ring, and the dilatation of the inteftine, from
the included matter.
The ring was of a blackifli colour, as the inteftine was alfo; and not only
within the facculus, but even within the belly likewife, to the extent of half
an ell. The reft of the inteftines were not turgid, although the abdomen had
been fomewhat tumid in the living body. He was prevented, by the very
filthy fmell of the body, from touching'any other parts of it, befides what he
knew were expected by me.
The cranium being open'd, he obferv'd the veflels of the meninges to be
muchdiftended with blood, and an extravafation of ferum. What I obferv'd
in the meninges, it is not the place to ipeak of here.
It is proper only to fpeak of fome things, which I faw in one of the tefticles
that was brought to me, and in its proper membranes, wherein it was even
then included.
Within the tunica vaginalis, was contain'd a water of a flight yellow co-
lour, but in fo fmall a quantity, as not to exceed a third part of a fpoonful.
Neverthelefs, from the tunica albuginea, where it inverted almoft the upper
part of the tefticle, which was in other refpects found ; as the other parts
that I examin'd likewife were; a roundifli corpufcle was prominent, which
was of the fame colour with the coat itfelf, and feem'd to be made up of the
fame fubftance.
28. A man who was a native of Trent, of a tall ftature, but not large in his
bulk, died of a difeafc, which I have already given you an account of in a for-
mer letter (r.)-3 as I alfo have of a fmall bone being found in his heart •, and of
frequent bony laminae in the great artery, (although in a curlbry manner) for
which reafon I fnall not repeat the relation here. I will rather add two things
that I obferv'd befides, in dilTecting his body ; in the month of March of the
year 1717 ; that you may have his hiftory as perfect as poifible.
The ventricles of the heart, and the large veflels, were not without poly-
pous concretions •, and thofe large, and denfe bodies, and fuch as, if you at-
tempted to draw them afunder, gave a confiderable refiftance : and yetfo great
a quantity of fluid and black blood, overflow'd in every part of the body,
that it was often t.v:e occafion of great hindrance, and trouble, in the dif-
itction.
In one part of the fcrotum the tunica vaginalis did not contain a great
quantity of water. But the furface of the albuginea, which was much
thicken'd, was befet, here and there, with corpufcles of the fame colour with
that coat •, of the fhape of very fmall glands ; hardilh in their fubftance, and,
in fome places, difpos'd almoft into the form of a quincunx.
29. The body of a man, who was faid to have died of a kind of pleurify,
was Drought into the college, when I was teaching anatomy there, about the
end of January, in the year 1750.
The thorax being open'd, a real complication of difeafes was found therein.
For there was a great quantity of water both in the cavities ofHhe thorax, and
4$f-the pericardium : the lungs, and particularly oa the left fide, were in great.
'-) Epift. 3..J1. 22.
' meafure
Letter XLIII. Article 30. 575
meafurc afKx'd to ihc pleura; and in (btne places a little hard: among thofe
glands which are at the firft divifion of the bronchia, was one of more than
an inch in length. I purpofcly omit here, what I (Trail fay with more pro-
priety on another occafion •, 1 mean that the triangular mulcles of the bread
were almoft wholly deficient; and this from the original formation: and
that, from the fide of one of the fibula.' internally, at its upper part, a bony
procefs, very fimilar to the ftyloid, had been prominent.
But I will not omit thefe things, f<*»xhe fake of which I began, principally,
to write this oblcrvation. The common coats of the teftes being taken off,
under that coat which is properly cali'd the fcrotum, I faw more fat, and
even at the lower part, than I fhould have expected ; particularly in a man
who was not very fit in general : and when I cut into the other coats on one
fide, I did not oblerve any moifture to flow from the cavity of the tunica va-
ginalis : yet the included tefticle had, near its upper extremity, a fmall redifh
excrefcence, prominent from the tunica albuginea.
30. After what I have already faid, it is to no purpofe to add the circum-
fbnee of the young man, of whom I (hall fpeak, in treating of the wounds of
the thorax (*) •, and much lefs of the man whofe hiftory I fhal! give, when upon
the fubjecl: of the gonorrhoea (s) ; although the former of thefe had in one
teftis, near to one of the globes of the epididymis, a fmall, redifh, and foft,
excrefcence of the albuginea, as it were ; and the latter a roundifh tubercle,
at the upper part of the epididymis •, yet neither of them had any larger
quantity of moifture within the tunica vaginalis, than may be feen even in
the mod healthy man.
For now it fufficiently appears, from the preceding hiftories, that not only
when one corpufcle was prefent, and even when many were obferv'd, there
was no great quantity of water in the tunica vaginalis ; but alio that there
was- none when a redifh excrefcence was ftill prominent : though this excref-
oence, not long ago, was confider'd, by me, as the token of an hydatid
being ruptur'd.
Notwithflanding this is the ftate of the queftion, as there is nothing which
forbids us to conceive, that the hydatid lately ruptur'd was very fmall, and
that fome, or many corpufcles, are the traces of old hydatids ; and finally,
that the orifices of the abfbrbent veffcls •, as in the tunica vaginalis of fome
perfons, they are very few in number or obftru&ed, for which reafon the
extravafated water is long preferv'd in them ; may on the contrary exile in
other bodies in a very great number, and be more open •, fince therefore we
are at liberty to conceive thefe things-, I do not fee that there is fufficient
reafon to oblige us intirely to fet afide thofe former conjectures.
But be this as it will -, from readir.g the obfervations that I have now pro-
pos'd, and from turning back to thofe which I have refer'd you to, you will,
gather that hydatids, cxcrefcences, and corpufcles, have occur'd to me, for
the moft part, at. the upper extremity of the teftis-, and even near the larger
globe of the epididymis: and that when they, were prominent in both cue
refticles, they occupied the fame place in both very frequently, and indeed
that the hydatid, of which I have taken notice above (0, as refembling the.
{*) Bpift. 53. n- 40. (i) Epift. 44.0.5. (:) N. 3,
. ' teftis
576 Book III. Of Difeafes of the Belly.
tcflis in figure and magnitude, was even form'd thereupon, or at leaft very
near to it •, as far as the delineation Teems to mow : which things are, perhaps',
not unworthy of obfervation, as their caufes may probably be inquir'd after
in the very near infertion of the fafciculus of the ipermatic vefTels.
But I fuppofe you will rather inquire of me, whether I never found the
hydrocele any where elfe, but betwixt the tunica vaginalis and albuginea.
And I will immediately explain to you, how it appears to me, that 1 law it
once, in the tunica albuginea itfelf.
31. An old man, who had fallen from a high place, in the month of
March in the year 1706, died of a blow on his head receiv'd by the fall-,
for which reaibn you will have the remaining part of his hiftory, when I treat
of thofe blows (u) •, at pqefent I fhall only give you an account of what re-
lates to the double hernia, under which he labour'd in one fide of the fcro-
tum only, and in the right.
The omentum, which was drawn towards the right fide, even in the cavity
of the belly, defcended from thence into a facculus, which was carried down
at the fide of the fafciculus of the fpermatic veffels ; but not extended beyond
the upper part of the tefticle. Internally it was fmooth ; and from thence
the omentum was very eafily brought back into the cavity of the belly.
The other hernia appear'd in the following manner. There was another
facculus much lefs than the former; that is to fay not longer than the tefticle,
yet fufficiently wide ; confifting of a fmooth and feparable membrane, and
containing a yellowifh. water. This fac furrounded much the greater part of
the tefticle, in confequence of having its fides clofely join'd, on one hand,
and on the other, with that part of the back of the tefticle, which was on
each fide, plac'd neareft to the epididymis longitudinally ; fo that this fmall
part was wholly on the outfide of the fac.
32. As I have, more than once, feparated the tunica albuginea into two
membranes, by an eafy, and equable divifion (x) •, and as I fee, that the cele-
brated Teichmeyrus (y) very freely increafes this feparation, and affirms
** that it may be divided into three evident coats •," I fhould fuppofe that
thisleffer facculus was made up of two of them, by the interpofition of wa-
ter : which kind of hydrocele is, as far as 1 know, not obferv'd by any other
author-, unlefs you, perhaps, fuppofe it to have been hinted at by our Fa-
bricius (2).
But that fpecies of this diforder, which men, in other refpects learned, af-
fert to be very frequent ; and which I acknowledge, not without a method of
cure, in that introduction (a), which is fo ancient, as to be alcrib'd to Galen;
that fpecies, I fay, has not ever occur'd to Valfalva, nor to me, nor to the
very experienc'd Heifter {b).
Yet I would not, for this reafon, deny, that it has even been feen very fre-
quently by others, who, without doubt, much more frequently defcribe water as
fhut up within the membranous cells, that are above the tunica vaginalis,
than as extravafated within this cavity.
(«) Epift. 52.11. s. (a) C. 18.
\x) Adveif. 4. anim-ad. i. (/>) Diflert. de Hydroc. n. 28. & Inftit. Chir.
[y\ Vindic. quorund. invent, in fine. p. 2. f. 5. c. 122. not. b ad n. 1.
(z) Pentateuch. Chir. 1. 1. c. 27.
Ic
Letter XLIII. Article 23- 577
It is long ago, that others, and among tlule Gerard Blafius (c), have ad-
monifh'd us, that this coat " docs not extend iitelf beyond the teftis ; and
" that the fpermatic vcfiels are not cover'd with any loofe tunica vaginalis :
*' but that, inftcad of this, a great number of membranes are given,
" which are condens'd together, and by this means connect thele ved'els :"
when the peritoneum, therefore, is ruptur'd in the groins, there is, fays he,
" no pallage allow'd, for any thing to flow down from the belly, to this
" fpace i that is into the cavity of the tunica vaginalis-, but, in fact, be-
" twixt this coat, and the fcrotum itfelf :" that is into the cells which lie
betwixt the two, and communicate with thofe fuperior cells, tidier naturally,
or from the effect of difeafe.
All thefe opinions are follow'd by many now, nor do I deny them ; nor yet
what they add, I mean that by the weight, or acrimony, of the humour col-
lected in thofe fuperior cells, that kind of membranous feptum, which is in-
terposal between the cavity of the tunica vaginalis, and thofe cells, may
fometimes be ruptur'd, or eroded •, and the humour, by this means, be pour'd
out, at length, into that coat : and thus one continued cavity will be pro-
due'd j that is to fay, of the tunica vaginalis, and the fpace which thofe upper
and diftended cells occupied.
In this manner they will probably explain that obfervation of mine(</), of
the vaginal cavity being produe'd quite to the os pubis •, and indeed I (hall
not be very obftinately repugnant to fuch an explication : although I do not
very well underftand, how it agrees with that, which not only is allow'd by
others, but by themfelves alfo; I mean that the hydroceles, like other fpu-
rious hernia?, " feem to increafe, as they afcend upwards towards the groins f
contrary to what the true herniar do, which " increafe as they defcend towards
" the teftis."
But if they alfo explain, after the fame mode, another obfervation of mine
(e) on the herdfman ; the cavity of whole tunica vaginalis afcended three in-
ches above the tefticles •, or even fome of that great number, wherein this
cavity being not more produe'd upwards than ufual, contain'd more or lefs
fluid •, it will be furprizing that not any one cell was ever left above the tu-
nica vaginalis, that I have feen to be diftended with a fluid : and even that
when this feptum is not ruptur'd, the humour has neverthelefs pafs'd into
the tunica vaginalis ; of which they deny the poflibility.
Wherefore, if I am to relate, with faithfulnefs, only thofe things that I
have ken (according to my ufual cuftom) in this place alfo ; I have no where
feen a fluid collected in the fcrotum, except in- the cavity of the tunica va-
ginalis ; if, befides the old man of whom we laft fpoke, you except the aici-
tic patients, in whom, however, it was feparated into thofe fmall cells that
fare immediately under the (kin, as has been explain'd in the thirty-eighth
(J) and forty-firft letters (g).
33. This hydrocele of afcitic patients, which they rather call a dropfy of
the fcrotum, it is by no means necefiary to account for, with the vulgar,
from that water wherewith their belly is diftended ; as the fame caufes, from
whence the water then very often Huffs up the reft of the cells that lie under
(1) In Obfervatis, fnpra ad n. 8. chads. (/) N. 26.
(a) Supra 11. 25. \g) N. 18.
'e) Supra n. 22.
Vol. II. 4- E the
578 Book III. Of Difeafcs of the Belly.
the fkin, may very eafily caufe them to be fill'd in the fcrotum likewife ; and
that fo much the more eafily, as this part is pendulous, and endow'd with but
little mulcular ftrength.
Yet I fliall not 'deny that, fometimes, by the great quantity of water,
which forces againft the peritonaeum, this membrane may be fo impell'd
within the fcrotum, that if you perforate this part, the water, defcending
thither from the belly, may burn: forth with great impetus \ as that very in-
genuous man Benevoli {h) relates that he had feen.
And as he fays that the ring of the abdomen was then fo dilated, as to be
able to admit a fift ; it affords me a handle for putting you in mind, that it
is not allowable to make ufe, or at leaft always, of a certain ingenious explica-
tion of the origin of the true hydrocele, in patients who have an afcites,
" from the oblique mufcle being too much ftretch'd," on account of the tu-
mour in the belly •> " and its orifice being by this means made narrower-,"
that is to fay, the oblong fi fill re which is generally call'd the ring, from
whence the fpermatic veins, which pafs that way, are comprefs'd.
34. However, the pre flu re of thofe veins is, fometimes, to be eafily
accounted for, rather from the very great weight of the incumbent waters,
while they pafs under the peritonaeum •, and how much effect this pre flu re
may have, in producing a hydrocele, I would fhow, if there were occafion,
by the example, in particular, which you will read in the writings of the ce-
lebrated Bafiius (i), I mean an example of a large hydrocele, which follow'd
the ufe of a bandage, that very clofely and ftrongly comprefs'd the groin ;
and that in a fhort time after.
Yet I knew an old phyfician, who, in order to intercept a defluxion of hu-
mours, as he call'd it, to a tumour of the tefticle, which was already consi-
derable, had order'd aftringent medicines to be applied to the groin ; as if
it were in the power of thefe applications to aftringe the artery, that carried in
the blood, and yet this without aftringing the veins, and the lymphae-du<5ts,fo
much the more in proportion, as their coats are more infirm.
When the apothecary who confulted me had heard thefe things from me ;
for the patient I fpeak of was an apothecary •, he immediately remov'd thefe
applications : and the other remedies made ufe of were of more advantage af-
terwards. And to omit the other caufes here, let us confider only the fper-
matic veins in an hydrocele, and moil other fpurious hernias •, for thefe are,
of themfelves, fufficiently prone to generate, and increafe, thefe diforders,
whether you attend to their polition, or their very great length, from their
beginning quite to their end •, or the more inert blood which they bring
back, in confequence of its being depriv'd of its more thin, and active, par-
ticles in the teftes •, or the remarkable fmallnefs of their fellow-artery, and its
very long courfe •, or the weaknefs of the cremafter mufcle that lies upon,
them •, or, finally, the valves in the veins themfelves being few, or none at
all; or perhaps unequal to their offices •, as appears from injections made to-
wards the teftes : particularly in thofe who have dilated thefe veins, by being
too intent upon venery, or venereal ideas.
{}>) Differtaz. 1. (/) Dec. 1. Obf. Anat. Chir. 9.
3 From
Letter XLIII. Article 34. 579
From thefc caufes then, which are fufliciently allow'd of by learned men,
and yet which are requir'd tor a proper fecretion of the K-men, thefe veins
are lb far fitted to bring on thole diibrders that I have rcivr'd to, or incrcafe
them j that if an intemperance of venery be ridded, it a compreffion, or a
blow, or any tiling elfe take place, from whence the motion of the blood,
through thefc vcllels, may be more retarded, thefe diibrders may e.ifily be
the conlcquence •, not to fay that if thefe circumfhmces are not avoided, they
may be increas'd.
And I even fee, that, from this retardation, the explication ofanobfer
vation, of Dodonneus, is dedue'd by a very learned writer; which oblcrva-
tion is even related in the Sepulchretum, in the next fection (&), and quoted
in this (/) •, that is to fay, of a hydrocele, when it is from an internal caufe,
always occurring in the left part of the fcrotum •, or, at leaft, as Hildanus (m)
has contracted that obfervation, " for the moil part."
For as to what they took notice of, in regard to the left fpermaric vein ;
as if it could carry the ferum into the fcrotum, from the neighbouring kid-
ney ■, though it has no place in our confederation at this time, yet this is very
well fubftituted in its room : that the blood is not carried back with eafe and
expedition, from that vein, into the emulgent.
But as to the example which is produe'd to explain the impediment ; as,
for inftance, if the neighbouring kidney labours under calculi, fand, and
ulcer ; and a very fmall calculus be carried from the ulcer, with the blood,
into the emulgent veins, and from this fall into the fpermatic, and difturb
the reflux of the blood from the teftes •, this example, I fay, is fo rare in an
hydrocele, that he who propofes it does not difavow, and even requires from
others, a more probable caufe of this very frequent circumflance ; I mean
of that which appears from his obfervation, at leaft:, that this diforder, oc-
curs " far more frequently" in the left, than in the right fide of the fcro-
tum.
But to me it feems that no other caufe need be inquir'd after here, than
that which has been already acknowledg'd •, agreeably to the opinion of fomc
of the moft learned men («) •, from whence the left kidney is more fubjett
to calculi, than the right.
For as the blood is not carried fo fpeedily, and expeditioufly, into the
vena cava, through the left emulgent vein ; in confequence of its being lon-
ger, and lying tranfverfly over the great artery ; as it is through the right ;
and the left fpermatic vein does not, like the right, open into the cava it-
felf, but into that left emulgent; it appears pretty clearly, that where the
blood is equally prone to ftagnation, in both the fpermatic veins, it will ne-
verthelefs more eafily happen that it ftagnates in the left ; or at lead afcends
more flowly •, than in the right.
Nor fhould I afilgn any other reafon, why the cirfocele " almoft always af-
" fedts the left fide," according to the oblervations of Arantius (o): though,
at the fame time, I leave it entirely undetermin'd of thefe, as I do alio of
thofe that I mention'd above of the hydrocele, whether they anfwer equally
with other obfervators. For it would be neceflary that a greater number of
(£) Sect. 30. in Schol. ad obf. i. («) Epilr. 40. n. 12.
(1) In Schol. ad §. 3. obf. 21. (0) De Tumor, p. n. c. 51.
(«) Cent. 4. Obf. Chir. 66.
■ 4 E .2 obfer-
58o Book III. Of Difeafes of the Belly.
obfervations, of mod of thefe obfervers, lhould be collected, in regard to
this circumftance, in both the difeafes -, and in thofe that Valfalva and I have
made, it unfortunately happens to have been but very ftldom ren.ark'd, on
which fide the obfervations were made.
35. But before I add a few things of the cirfocele, I (hall hint dill fewer
things of the pneumatocele, and of the hematocele, as the order propos'd
(p) requires. For this laft I have never feen, as it is feldom of long continu-
ance like the reft.
For when blood, either from a wound receiv'd, or from any curative me-
thod, has flow'd down into the fcrotum, furgeons immediately open a paf-
fage for its removal ; following, therein, not only the precept of Celfus (q)>
but of reafon itfelf. Yet fometimes from the erofion of the membranes of the
tciticle, " a remarkable quantity of bloody ichor" diftends the tunica vagi-
nalis •, fo that when this membrane is incis'd, " it burfts forth with impe-
" tus," as I find in Juftus Schraderus (r).
But if we take the word pneumatocele in fuch a fenfe, as tofuppofe it ow-
ing to air being included in fome interline, which has defcended into the
fcrotum ; a remarkable example of which kind has been produe'd by the ce-
lebrated Haller (s) in particular •, I have perhaps in fome meafure feen it :
but if from air diftending the cells of the fcrotum, in which manner moft au-
thors underftand it, I do not remember to have read that any one has feen
this, without an emphyfema, of all the other parts, or moft of them ; or, at
leaft, as you have it in Palfin (7), of the parts neareft to the fcrotum. How it
appear'd to me in the fcrotum alone, in a body already dead, you have in the
fifth letter (X).
36. The cirfocele is the only one of all the different fpecies of hernias, that
Cornelius Celfus has given the name of ramex, or ramices, to ; whether it oc-
cupies the fcrotum ; and that either externally or internally ; or, at length,
whether it only fill the groin : and as he propofes this order not in the feven-
teenth, but the eighteenth chapter, of the feventh book ; fo he follows it,
by treating of the cure, in chapter the twenty-fecond, and twenty-fourth.
And this remark I was willing to make, left, like a man in other refpects
very ingenious, you lhould be in fome doubt about the term ramex in Cel-
fus j and this his laft chapter lhould feem obfeure to you : in which it is
true he gives us the method of cure in the bubonocele, as the conclufion of
the eighteenth chapter teaches ; but of a bubonocele which has its origin only
from varicous veins.
Juftus Schraderus is obfeure*, whom I the more readily mention to you,
becaufe I fee that his obfervations are omitted in the Sepulchretum. For in
that very obfervation which is pointed out alittle above (x), wherein hefpeaks
of a certain hydrocele, he alTerts that there were alfo " innumerable flexures
** of creeping veficls immoderately turgid;" but whether " on the furface'"
of the tefticle, or the tunica vaginalis, is uncertain from what he fays: for
(p) N. 15. (/) Anat. du Corps Hum. p. i.tr. 2. ch. 18.
(?) De Medic. 1. 7.C. 19. («) N. 19.
(;•) Dec. 2. Obf Anat. Med. 1. (*) N. 35.
Is) Ad Prxleft. Boerh. $. 641, not. u,
that
Letter XLIII. Article 37. 581
that thefe appearances may be in either place, Celfus has taught us in the
eighteenth, and tvventy-fecond chapters, already quoted.
Moreover, as in the obfervation of Schradcrus, fo I obferve, that it hat
frequently happen'd in others likewife, chat hemic of different kinds were
join'd with the cirlbcele. Turn to Horltius whom you have here in the S
pulchretum (y). And even read over again the paflages of mv letters, where-
in this hernia is defcrib'd, as it was feen by Valfalva, or by me.
The firft-mention'd author (2), having feen, according to the firft mode of
Celfus (a) " the varicous veins lb entangl'd with each other, upon the fcro-
" turn itfelf," as to refemble a chain -, found a hydrocele at the fame time.
And I having, according to the laft mode of the firft divifion of Celfus {b)t
found an incipient cirfocele in the butcher (c), or a compleat one in the pot-
ter (<i) ; I, at the fame time, found in this lafl:, the beginning of a hydrocele -%
and in the former a compleat hydrocele.
Befides, the fubftance of the teftis was fo compact in the potter, that it
feem'd, as Celfus fays upon that mode of difeafe (e)y " to have loft its nou-
" rilhment j" and had a very fmall bony body lying beneath it : and this
brings back to my mind, another particular obfervation of Valfalva, which
was made on I know not what man.
For in the right fafciculus of the fpermatic veflels, he found a bony body
within peculiar little membranes : which, when he prefs'd it betwixt his fin-
gers ftrongly, he law to be made up of two bones. Both of thefe were of a
globular figure ; but one of the bignefs of a grain of millet-feed, the other
of the bignefs of a vetch ; the latter in part roughifh, but the other elegantly
fmooth, or polifh'd, like pearl.
However, Arantius (/) obierv'd thefe things of a cirfocele, defcribing a
very large one I fuppofe: "the veflels offer them felves to the touch in fo
" turgid a ftate, as to equal a finger in thicknefs •, being wrap'd up in cir-
" cles, and folds (after the manner of the inteftines) which in part difappear
" when the patients lie down, are diminifh'd and become lefs troublefome,
" in the winter-feafon, when the fcrotum is contracted ; but are exceedingly
" fo in the fummer."
37. The fteatocele is, with the fame author (£), " where a certain adipous
" humour concretes in the fcrotum, and about the teftis." And he has fol-
low'd the ancient writer of that introduction, which is preferv'd among the
books of Galen ; which writer having, in the feventeenth and eighteenth
chapters, mention'd the fteatocele among other hernia, fpeaking of the cure,
in the laft-mention'd chapter, fays that " the fat muft be remov'd."
But whether we choole to call it a febaceous matter, or fat •, whatever of
an unctuous nature is fometimes form'd within the fcrotum, and diftends it,
that is certainly either collected under the fkin itfelf, or in the internal cells.
To the firft kind belongs that of which I have faid above (b), that I had
feen, under the fcrotum properly fo call'd, more fat, and even at the lower
(y) L. 3. feft. 29. obf. 17. (d) Epift. 7. n. II.
(z) Epift. 20. n. 24. (e) Cit. c. 18.
(a J L 7. c. 18 & 22. (f) C. fupra ad n. 34. cit.
(I) Ibid. (g) Ibid.
(c) Epift. 21. n. 19. (6) N. 29.
party
582 Book III. Of Difeafes of the Belly.
parr, than I mould have expected •, particularly in a man not very fat : for
there is no fat in that part, or at leaft but very little •, and this only fome-
times.
But that was a kind of beginning only of this diforder •, which you fee
compleated in this twenty-ninth lection of the Sepulchretum (*'), from de
Graaf: and to the fame clafs, probably, is to be referr'd that which is
to be read of, in the fame place (£), in the obfervation of Horftius already
taken notice of: " an adipofe flefh in the right part of the fcrotum."
And to the internal cells belongs that which, as was faid above (I) for an-
other reafon, was found by the celebrated Petfchius (m) in a body that was
very fat ; when that which feem'd to be an enterocele, or epiplocele, in one
fide of the fcrotum, was nothing but " fat collected in the cellular fubftance
" of the peritonasum, and paffing down through the rings to the fcro-
" turn."
Thus, in Boerhaave («), you will read that a very large tumour was feen
by him in the fcrotum ; for in a fat man " the luxuriant fat had pafs'd through
" the ring into the fcrotum, with the fpermatic veffels ; the tefticle being
" quite found and free."
And Schulzius (0) feems to have found " a large quantity of fat" not be-
low the groin, and on the right fide, a much lefs quantity being on the left,
and " clofely interwoven" with thefe vefiels-, fo that, at firft fight, it re-
fembl'd an inteftine, or the omentum, prolaps'd thither: and that in a car-
cafe rather lank and thin, as you will remember to have been related by
me before (p), in order to illuftrate a different circumftance.
To me, however, who know that I have fometimes feen fat interpos'd,
here and there, betwixt thefe vefiels, even in a lean body, from the upper
part of the tunica vaginalis quite to the ring •, for I particularly obferv'd this
tract at the time •, and that in a very brawny man, by no means fat, who
was kill'd when in perfect health, I not only found fat in the lower part of
the fame veffels, but alfo betwixt the epididymis, and the teflis ; and finally,
that in the herdfman, fpoken of in this letter (q) (who was not fat likewife)
where the thicker fafciculus of them, which belong'd to one teflis, was made
up of fat in its greater part, fat was not wanting betwixt the other tefticle
and its epididymis (which circumftance, although, as far as I remember, not
taken notice of by anatomifts, is perhaps not uncommon) ; to me, I fay, it
does not feem fo furprizing, that fat has been, more than once, found immo-
derately increas'd in the fafciculus of thofe veffels, as that it has never been
found betwixt the epididymis and the tefticle ; unlefs, perhaps, fat has been,
at any time, taken for flelh, in any kind of farcocele.
38. For the author of the " Introduction (r) " juft now quoted, takes
notice not only of red flefh, but even of flefh " of a whitifh colour •," as
compofing a farcocele ; and I myfelf, as I have faid in a former work (j),
(i) Obf. 14. §. 2.
(*) Obf. 17.
(/) M. 10.
(th) Syllog. anat. obf. §. 89.
\n) Pilled adlnftit. §. -j\z.
have
(0)
Aa
. n. c.
torn
1
. obf. 225.
(p)
N.
io.
(1)
N.
22.
(r)
c.
18.
(')
Adverf. A
nat.
2.
Animad. 6.
Letter XLIII. Article 38. 583
have feen facculi of Air, which, as this fat was ting'd by ftagnating blood be-
ing intermix'd with it, rcfembled flefh.
Moreover, in regard to the nature of this hernia, and its fituation, diffe-
rent phyficians have entertain'd different opinions •, and thole immediately
repugnant to each other. For Velalius, as you will learn from the Sepul-
chretum (t), had perfuaded himlelf that it confided of the omentum pro-
laps'd into the fcrotum. .
Some have thought that it did not differ from the tumefaction, and indu-
ration, of the teiticle. But the others •, although they do not deny that lefs
cautious obfervers may fometimes be impos'd upon by the firft of thofe dif-
orders, fo as to take it for a farcocele-, by this name, neverthelefs, under-
Hand a flefh really growing out about the tefticle, and its veflcls, or fome
other fubftance of that kind.
Yet this feems to happen " very feldom," as Celfus (u) has admonifh'd
us ; or at leaft lefs often than is generally fuppos'd •, if we look for obferva-
tions which are not liable to doubt : and perhaps Olaus Borrichius does not
leem to have wander'd far from the truth, when he remark'd, upon his own
obfervation, as you have it in the Sepulchretum (x), " that a farcocele is
44 not fo frequently form'd upon the teftes, as in them :" where he has alio
lhown how a hydrocelele may fometimes refemble a farcocele ; fo that, per-
haps, it was the former, and not the latter, which they believe to have been
taken away by the powder of the root of ononis or reft-harrow ; which cer-
tainly increafes the quantity of urine.
He has, therefore, prudently attributed fo much to that opinion, which I
mention'd in the fecond place, as, neverthelefs, exprefly to leave room for
the third alfo, for which he fhows, that the examples, in Lotichius, and Hil-
danus, argue. Looking for thefe examples, I eafily found them in the fixth
of the Confilia of the firft-mention'd author (y)t and in the fourth Centuria
of the obfervations of the latter ; and wonder'd that nothing was transfer'd
into this fedlion of the Sepulchretum, from the fixty-fifth obfervation of this
author.
But if thofe things which were thoroughly examin'd by anatomy were fought
after-, there was an obfervation of Blafius (2), that might be refer'd to this
clafs •, in which, not as in that of Borrichius, the whole flefhy mafs was no-
thing but the teiticle itfelf ; but, on the contrary, the tefticle was contain'd,
like a nucleus, in a thick cortex as it were, which feem'd to be made up
of pretty hard glands.
I however, though I do not at all doubt, but a morbid flefh may grow out
from the coats of the teftes, when eroded, from whatever caufe it may be ;
as well as from the coats of other parts ; have never yet lit on an appearance
of this kind in difTections.
But the celebrated Pohlius (a) has lit on fuch an appearance, and has faid
that a farcocele is, " according to his own obfervation, a fibrous and flefhy
44 tumour of the tefticles ; more or lefs hard and painful, and form'd by de-
44 grees ; which either increafes the whole fubftance of the tefticle, and con-
(t) Seft. hac zcp.obf. 15. §. 3. (z) 15. Partis 1.
(u) L. 7. c. 18. (a) Progr. de Hern. & Speciatim de Sarco-
\x) Sed. cit. Schol. ad obf. 22. §. 1. ceie.
OO C. 3. obf. 9.
" verts
t(
t<
584. Book III. Of Difeafes of the Belly.
11 verts it into a mafs like flefh ; or, at lead, growing to a part of it, forms a
" kind of flefh y excrefcence as it were."
Nevcrthelefs you fee, that he acknowledges it to be principally in the
whole of the tefticle : and he produces an example of a farcocele difiefted
by him, in which the fubftance of the teftis, " had been univerfally chang'd
'' into a purulent matter."
And if you read thofe obfervations, of that very experiene'd man Dicteri-
cus Sproegclius (b), wherein the hydrocele is join'd with the farcocele ; as
a cauie, or as an effect; you will fee that the tefbicle was found to be " livid
" and black, putrid," or " extended, hard, and, on the outfide, together
" with the epididymis, corroded and callous •," or " partly friable by means
" of putrefaction ; but in part perfectly cartilaginous, and having the tunica
albuginea alio, together with the epididymis, univerfally cartilaginous /' or
rinally " tumid," and having, when it was difTected, " a true yellowifh thick
pus in the middle, with an erofion and incipient callofity of the parictes."
In no more than one obfervation (c), is it faid that " tumid and fcirrhous
glands" were found •," but not in the fubftance of the teflicle : were they
then upon the furface of the tefticle ? Or in the fpermatic rope ? For in this
they alio acknowledge a farcocele, and do not at all treat of it, if it has en-
ter'd into the belly, like that which I have defcrib'd, as feen by Valfalva, be-
ginning in the teftis (d), and afcending thither, like a hard tuberofity, as if of a
glandular nature, where it was join'd with a very large and fimilar tumour of
the mefentery.
But not to digrefs from the fubject of farcocele, when enquir'd after in the
teftes themfelves, the obfervations of that illuftrious man Heifter (e) are ex-
cellent. This author found four tefticles fuch as he delineates (/), all of
them fo immoderately enlarg'd, that he, with juftice, refuted the opinion of
thofe (g), who have aflerted that a farcocele " never exceeds a hen's egg in
" its fize."
He alfo found them all fcirrhous, and of an equal furface ; fo that it was
not without reafon he affirm'd (b) " fcirrhous tefticles to be far more frequent,
** than excrefcences from the tefticles."
The remaining circumftances you will fee in this author himfelf; and
among others, that one of thofe teftes (/') was " corrupted, and, in a manner,
*' cancerous." In the mean while, let us go on to the laft of the hernias
enumerated by us.
39. By the name of fpermatocele, the author of the twentieth obfervation,
in this twenty-ninth feciion of the Sepulchretum, has underftood a hernia,
which is made by " the vas deferens being " corrugated, and going down
*' into the fcrotum ;" but very eafily returning within the belly, either by
the help of the hands, or a fupine pofture of body.
Who this author was, I enquir'd, by looking under the obfervation, to
no purpofe •, though I much wifh'd it, that I might better be able to con-
ceive his meaning. For under it is written idem ibidem •, that is to fay, either
(i) Obferv. qusdam felett. §. 50. & feq. (f) Fig. 1. & feq. cum. explie.
(c) §.51. (g) In Proemio.
(d) Epilt. 39. n. 2. (b) §. 37.
(<r) Diffeft. de Sarcocele. (;') $. 34.
Rolfinck'
Letter XLIII. Article jg. 585
Rolfinck, or Riolanus, or Hiklanus, or Rolcius •, for thefe had all been men
tion'd in the preceding fcholia, and observation.
I knew, however, that thole were not the worth of any of thefe authors
and it happen'd, by mere accident, at bit, that, turning ov r Barbette's
furgery (/:), I lit upon thefe very words ; and did not find any thing more
than what is copied in the Sepulchretum.
It is certainly difficult to be understood, by thofe who are not ignorant
how the vas deferens is connected, by adhering to the bladder, and lying up-
on the ureter in its paflage (from whence Rutty (/) accounted for the draw-
ing up of the teftis in nephritic pains) and finally, how it is tied down, by very
frequent cellular membranes, to the neighbouring parts, not only above the
ring of the abdomen, but beneath that alfo, quite to its origin •, it is difficult,
I fay, to be underftood, by thole who know thefe circumstances, how this vas
deferens can poffibly deicend fo far into the fcrotum, as to produce a hernia,
by its being wrap'd up together there.
• And as 1 do not remember that this has been ken by any one hi diffection j
and as Barbette does not fay that he faw it by thefe means-, I think there is
room to fufpect that what he fays he had more than once feen, was quite a
different thing from that which he has fuppos'd it to be.
The fpermatocele therefore •, which, if it Signified to me what it did to
Barbette, ought to have been confider'd above, in the number of the true
hernias •, is retain'd among the fpurious hernia •, and fo underftood, as to fig-
nify " a collection of femen in the tefticles," which fometimes " raifes them
" up to a very great bulk:" and I ufe the words in which the compilers of
the *' Bibliotheca Anatomica (m), have propos'd this fubject ; requesting that
they might be allow'd to call herniae of this kind, " Spermatoceles :" for
this fignification, and ftill lefs this word, was not lately made common
among phyficians, as a man, in other refpects very learned, fecms to ima-
gine.
And indeed thefe compilers have afHrm'd, that the cafe has been " more
" than once" remark'd by them, in men of a very falacious difpofition, when
there was " an obstruction form'd in fome part of the epididymis, from the
" particles of the femen that are capable of concretion ;*' and that they had
once feen the cafe, beyond all poffibility of doubt, when, after the eSfufion of
the femen, thus confin'd, into the fcrotum, an abfeefs having ariSen from
thence, which was under a neceffity of being open'd with the knife, this abv
fcefs, when cleans'd, did no more difcharge pus •, but from that part of the
epididymis, which is in the middle betwixt the globes thereof, the femen,
which had burft through that parr, by distending it, very evidently camo
forth.
But if you choofe rather to attribute this foramen, of the epididymis, to
the eroding matter of the abfeefs, than to the distending femen-, you never-
theless cannot deny what is dictated by reafon itSelf, if the paSTage of the fe-
men, into its veficles, be intercepted from any.caufe whatever ; or if the return
(&) Part. i. c. 7. (m) Tom. 1. in adnot. ad Graaf. Trnct. de
(/) Treatife of the urinary paffages, fedl. 3. Viror. Organ. & est.
P' Vol. II. 4. F or
586 Book III. Of Difeafes of the Belly.
of it, by the abforbent veffels, into the blood, from the vcficles that are al-
ready diftended, be prevented ; I mean that the tefticles themfclves, the epi-
didymis, and the other receptacles of that fluid, will be fo fill'd by the new
lemen which is continually fecretcd in the teftes, that at firft they become
iwell'd •, at which time I will fay that there is a fpermatocele ; then after this,
that the very tender and foft ftructure, which is peculiarly obfervable in the
tefticles, will be, by degrees, vitiated : and the veifels which carry the femen,
blood, and lymph, being ruptur'd, at length tumours of a mix'd kind will
be generated in the teftes.
Now I will give proofs of thefe things from examples.
40. Some perlons, whole ilia were diftended with flatus, have complain'd
to me, not fo much of a tenfion, and pain, as of one, or of both tefticles
being for the moft part tumid, in particular, when the flatus was moft
troublefome; not the leaft inconvenience remaining when the flatus was dif-
lodg'd.
1 fuppos'd therefore that the paffage for the femen was fhut up by the
diftention of the inteftines ; the veffels that carry this to the veficuU being
comp.refs'd, and even the veficles themfelves fometimes ; fo as not to admic
what was brought down to them.
Thus I alio remember, that, thirty years ago, when one Rhodigi, a man of
credit and reputation, came to me (being fubject to a certain tumour, which had
return'd more than once, betwixt the muicles of the abdomen, in the right
epicolic region) and faid, that as often as the tumour was prefent, the teftes
below that became very difagreeably heavy, fo that he was oblig'd to receive
the fcrotum in a bag, and fuftain it thereby ; I remember, I fay, to have ex-
plain'd the cafe to the patient, and the phyficians, (who were prefent with
me in conlultation) even at that time, in luch a manner, as to fay, that when
the oblique mufcle, on the right fide, was ftretch'd in confequence of the tu-
mour, with which it was affected, and the oblong fiffure thereof, which is
cail'd a ring, of courfe conftring'd ; it was not to be wonder'd at, if the tube
which carries the femen, and paffes through this fiffure, being in fome mea-
iure aftricted, the afcent of the femen be, in fome meafure alfo, prevented.
Yet in this man, and in the former likewife, it may perhaps be; notwith-
ftanding there were no proofs of the blood ftagnating ; that the fpermatic
vein being equally comprefs'd, or ftreighten'd, thefe fymptoms which I have
fpoken of, were no lefs to be attributed to the obftru&ed blood, than to the
ob ft meted femen.
And there is, among the letters of Valfalva, one which was written to a*
certain prince, one of whofe teftes had, after marriage, grown out to the big-
nefs of a hen's egg.
Valfalva imagin'd that this tumour might be from the ftagnating femen,.
and not without reafon •, becaufe the patient was not wont to emit his femen
with eafe, though in other refpects he abounded therewith : fo that fometimes
he was oblig'd to defift from the venereal congrefs, without having made it
corripleat.
Jn like manner, in a youth of whom Hildanus gives the hiftory {n) ; the
fummary of which is in the fcholium on that obfervation of Barbette, to
(«) Cent. 4. obf. 64. Exempl. 1.
2 which
Letter XLIII. Article 41. 587
which I have refcrM (0), in the Sepulchretum ; who would account for the
pain of the groins, and the tumour of the tclticlcs, not from femen, but
from blood; as they had been the confequents of the ejaculation of femen
being fupprefs'd, alter having been about to be thrown out ?
Both of thefe tumours vanifh'd on the left fide indeed: on the right, how-
ever, the tumour not only continued, but, in procels of time, grew out into
a very large flefhy hernia. The fame thing would have happen'd to another
man, from the fame calife, if the celebrated Craul'e (/>) had not, by a very
extraordinary fuccefs, refolv'd a tumour, which had already increas'd to the
fize of a large human fill, within two years.
But what was the event of a tumour of the fame kind, and arifing from
the fame origin, which I law in a man of noble birch, 1 cannot learn : for I
have heard nothing of him fince he jult confulted me upon it ; at which time
he was only palling this way, and immediately continued his journey.
He, certainly, might have made trial of every kind of remedy, but the
furgeon's knife, to no purpofe ; if the tumour was of that nature of which it
was in a young man (q), who had a mafs of very white, and folid, flefli,
arifing from a caufe nearly fimilar, cut out from his fcrotum, in the center
• of which flefh was contain'd a bony body of a globular figure.
But why in thefe four perfons, either one of the teites only fwell'd, or
continu'd to fwell-, and not both of them ; fince the femen mult.be obltruct-
ed in both of the teites equally, by having its eliux prevented in the very
middle of the venereal congrefs, it is not very eafy to lay ; unlefs we perhaps
conjecture, that the quantity of femen, on both fides, was not equal -, or that
the fluxility of the femen, or the force of the coats, and the cremalter mufcle
was not the fame ; or that the abforbent veffels on one fide, were more open
than on the other ; or fomething elfe of a fimilar nature.
41. Tumours, however, of the teites ; from whatever caufe they have their
origin-, feem to confilt of different matter in different perlbns •, as, for in-
ftance (befide the examples hitherto propos'd) of a flefhy and nervous fub-
ftance, in Borrichius (r) •, of a glandular fubltance, and velicles full of blood,
in Bartholin (j) ; of a " ligamentuous," and in part approaching to the na-
ture of a cartilage, in Schraderus (/) ; and of a cartilaginous fubltance in
Ruyfch (u).
And 1 myfelf having, in a man of whom I fhall take notice, when on the
fubject of the gonorrhoea (x), feen the right tefticle, in particular, larger
than it naturally is ; found, upon difledtion, a little fat lying betwixt the in-
nermoft fubltance of it, which was in other refpects not much difeas'd.
From hence I conjectur'd it might happen, that fome tumours of the teites
may be, now and then, found to have their origin from fat preternaturally ge-
nerated, and increas'd. And if I had feen, and been at liberty to difTecl:, in
the dead bodies, thofe very large tumours that I have fometimes {ccn in
J» N. 39. (s) Ibid. §. 2.
(p) Eph. n. c. dec. 3. a. & 6. obf. 282. (/) O'of. fupra ad n. 35. cit.
(q) Hilt, de l'Acad. R. des Sc. a. 1700. (») Thef. Anat. 9. n. 51.
obf. anat. 4. (x) Epifl. 44. n. 5.
(r) Sepulchret. f. hac. 29. obf. 22. §. 1.
4F2 the
S
588 Book III. Of Difeafes of the Belly.
the living body^ I do not doubt but I muft have obferv'd fomething Angu-
lar, if the ftru&ure had correfponded to the bulk.
For firfr, I faw at Bologna formerly, one fo large as to be almoft equal to
that which Ruyfch (y) faid was of a " prodigious, magnitude-," or, if he
fpeaks of the fame in his cur^epofleriores (z), as he feems to do, " the largeft ever
*' feen m the human body." But though it was of a fmaller fize, I heard, ne-
verthelefs, that it was not taken out with fo good fuccefs, as that larger one.
After this I faw, at Padua, a teftis of fuch a magnitude, that unlefs you
very well knew how far I may be depended upon, I durft not write it to you -%
fearing lead you mould fufpect me of fallhood. For if that of Ruyfch ex-
ceeded " the head of a human fcems ; this, whereof I am fpeaking, certainly
exceeded the heads of two men join'd into one.
Wherefore, that I might examine fo very extraordinary an appearance ; in
the month of May, in the year 1730, when the man was paffing this way, in
order to go to Efte, where his habitation was ; Anthony Mocenici, that illu-
ftrious chevalier, and very worthy of his brother Aloyfi, at that time Doge of
Venice, would have him come to my houfe.
Where, upon firft feeing the man, being ignorant who he was, and why
he came to me, I mould have fuppos'd him to labour under a very great afcites,,
if I had not obferv'd his belly, as it was (till cover'd with his garments, to
be tumid only on the right fide.
But when all the coverings were taken off, and the bandages, by means
of which he jcept the tumour drawn up to theabdomen as far as the hypochon-
drium, where it naturally tended of itfelf, remov'd j being furpriz'd at that
bignefs which I have mention'd, I began to handle it •, for it bore the touch,
very well, being always without pain ; and I feem'd to myfelf to touch a kind
of farcoma of the form of a fpheroid, and every where cover'd over with its.
(kin,
Upon my afking how, and from what caufe, it had begun, the patient
anfwer'd, that notwithftanding he had receiv'd the blow when a child, the
tefticle neverthelefs did not begin to grow out into a tumour till he was at
man's eftate j but that it had at length grown out into this bulk in the fpace
of a few years.
42. But it is neceflary, here, to put you in mind of one thing; I mean,
that Valfalva, as it (lands in his papers, had feen the increas*d magnitude of
the teftes to be, for the moft part, owing to the diforder of the coats that in-
verted them.
Nor is it difficult for me to believe this, efpecially in fome particular cafes ;
fince, as I have faid in the preceding letter (a), having found the tefticles
to be bigger than they naturally are, and confiderably tumid, I perceiv'd this,
not to arife from a detention of their fubftance, but from the coats being
much thicken'd : and, indeed, in hernias, both true and fpurious, I have-
obferv'd the thicknefs of the membranes, wherein they were contained, to be-
much increas'd.
So in the hydrocele, which I defcrib'd above in the foldier (b\ I remark'd
that the tunica erythroides, and vaginalis, were thicken'd ; as I did elfewhere
(y) N. 51. cit. & tab. ibid, 3.. fig. 1. {a) N. 28.
(«) N. 28. (I) N. 17.
in.
Leiter XLI1T. Article 42. 589
m a butcher (c), who was affected wil!i hernia: of the fame kind, that both
the vaginal coats were very denfe. Thus in the cpiplocele of an old man (J),
I round the peritonxum, which compos'd the facculus, to be dilated, and
at the lame time become much thicker-, and in the cntero-epiplocele (e) of a
young man, the coat of the facculus was not lcfs thick, and firm, than that
of the pulmonary artery ; and in the crural hernia of a woman (f) it was lo
thick, that it could be divided into many different laminae, as it were, with-
out any great difficulty.
Yet it may happen, where the orifice of the facculus is much more large
than the ring, as is the cafe in very great hernias-, or where hernias hap-
pen in thole places, in which the tendons of the mufcles are, in their na-
natural Hate, quite unperforated ; as is the cafe betwixt the recti and the
obliqui, or above and below the navel, betwixt rectum and rectum ; it may,
I fay, happen, that the thicknefs of the facculus is not only from the perito-
naeum, but, in general, from the tendons alio, which are driven outwards
together with the peritonasum.
Mery (g), therefore, in that hernia which was made up of almoft all the
fmall inteftines, faw not only the peritonaeum produce itfelf into the fac, but
alio the feveral tendons of both the oblique, and of both the tranfverfe muf-
cles, and that very evidently : and how far Waltherus faw thefe three ten-
dons alfo extending themfelves in a hernia, and fuftaining a great weight of
the inteftines ; though not to be compar'd with that of Mery ; and refilling,
as far as poffible, the farther growth of the hernia (which ufe he l&ewife
thinks they,perform in other hernias, and that not unfrequently) you will learn:
from the Acta Eruditorum that are publifiYd at Leipfic (b).
But, although Mauchartus (;') not only delineates a lamina, arifing from
the tendinous fibres of the external oblique mufcle (&), but alfo propofes it
among the other coats of the hernia, by the name of tunica aponeurotica ; yet
you may eafily call to mind, how far I have faid. thefe are allow'd of by
me.
Nor does it efcape me, that there are very excellent anatomifts who deny
that thefe appearances could be feen in hernias difTected by them.
And as I very readily give credit to them, fo I fhould not be ready to fup-
pofe that Mery, and Waltherus, thofe excellent diffecters in other hernias ;
for they did not fpeak of all ; could not, as they made ufe of fo much dili-
gence in that inquiry, have feen what they fay they had feen.
However ; to lay afide this controverfy in the mean time ; there are fuffU
cient examples which relate to thofe coats, that are univerfally acknowledg'd.
in hernise, to make it appear, how. the tefticle •, which has not of itfelf be-
come fo tumid •, may feem to have attain'd to a very considerable bulk, chiefly
from the thicknefs of thefe coats being increas'd.
There is a fecond obfervation of the fame Waltherus, propos'd in the fame
acts (/), in which the fcrotum, and the penis, are defcrib'd to be fo tumid,
(r) Epift. II-.. n. 19. (b) A. 1738. M. Jun. p. 2.
(d) Ibid. n. 15. (;) Differt. & caet. fupra ad n. 3. cit.
(e) Epift. 34. n. 9. (i) Fig. 2. ad DD.
(f) Ibid. n. 15. (I) A. 1785 M. Novembr. cum tab. 5. fig. 1.
(^) Mem. de PAcad. R. desSc a. 1701. obi".
ana*. 5. that.
3
590 Book III. Of Difeafes of the Belly.
that the latter extended itfelf to the knees, and the former below them ; the
thicknefs of each of tliefe parts correfponding to this length.
And I do not remember any obfervation to have been more fimilar here*
to, than that which was fent to me, in print, in the year 1755, from Syra-
cufa, and confirm'd by the public teflimony of the city. But this was from
a living man •, and that of Waltherus was made even on the dead body.
In this laft therefore, upon examination, the fkin of the fcrotum was found
to be three times as thick as is natural-, and the cells that lay beneath, and
•went betwixt the tefticles, were fo diftended with a tenacious humour, as to
relemble a heap of inert flefh ; to which the weight of the whole tumour,
that is to fay, of almoft fifty pounds, feem'd to be principally owing.
The tefticles indeed, were much larger than their natural fize ; as the
thicken'd albuginea contain'd a fluid, and tophaceous concretions, fo that
but a very fmall part, and that in one fide only, was left free for the flender
tubuli, which compofe the fubftance of the teftis, to occupy.
But how very little a part of the genera] tumour, then, was form'd by
thele tubuli, you very well conceive. That very excellent man Heifter (m)
has therefore fuppos'd, with great fagacity, as he generally does, that this
was a tumour rather of the fcrotum than of the tellicle: nor did he judge
differently of fome ethers, the difledtion whereof we have not •, among which
is that of fixty pounds weight, fpoken of in the hiftory of the Royal Academy
of Sciences at Paris (»).
For this very experiene'd man (0) knew, that, even in a hydrocele, and
efpecially one of long Handing, the coats of the tefticles, and particularly
" the dartos, and vaginalis, were often very much thicken'd •" fo that he
had feen them equal to the thicknefs " of five or fix lines, and more:" for
which reafon he has admonifh'd us, that it was, for the moft part, very
difficult to perforate them," with the point of a triangular inftrument; and
that on this account (p)> the point of iuch an inftrument " ought not to be
* too haftily withdrawn, becaufe otherwife the coats would not be piere'd
k< through."
And indeed, how much the tunica albuginea may be thicken'd in a farco-
cele, he has, doubtlefs, left us to conjecture ; when, after cutting into that
coat, with the expectation of feeing the feminal veflels large, and very much
diftended, he found them " equally fmall as they generally are in a found
" and natural tefticle, which," fays he, " is greatly to be wonder'd at, in
" fo confiderable a diftention of the tefticle."
And that you may have another example of this coat being thicken'd, ex-
amine that figure of a human tefticle become bony, which is given us by the
celebrated Reinholdus Wagnerus (q). When you have feen how much larger
this was than the natural tefticle, then obferve that the " furface" of it only,
" of the thicknefs of a pidgeon's quill, had been chang'd into a very hard
*' bone ;" that externally it was rough with bony tubercles, of the bigncis
of a pea; but internally fmooth •, where it comprehended a fmall cavity, in
which " the gelatinous matter of the corrupted femenlay hid."
(/;„•) Diflert <Jc Sarcoele, §.36.
(;/) A. 1711. cbf. anat. I.
(i>) Diflert. de Hydrocele n. 32.
(P) N. 36.
(q) Epa. n. c, cent. 1. obf. 30.
That
Letter XLIII. Article 43. 591
That is to lay, the fubftance of the teltis, formerly included, was now an-
nihilated •, and the bony i'urface was owing to the tunica albuginea being
made thick.
43. However, although this letter is really fhortcr than the former, as I
promis'd you, I omit to add other tilings at pic lent, on the fubject of hernia;
and tefticles : and lhall not even fubjoin any thing in regard to the pain of
thefe parts, unlefs that you may read the obfervations, which 1 pointed out
above fr), from celebrated authors j and that, in thole wherein you will find
there was pain j and you will find this in many •, you will attend to the date
in which the telticle was.
At the fame time, you will readily learn from one of them, which is Hei-
fter (j), in what manner, not only in that patient, but in another alio,
whom Sproegelius defcribes (/), pains may be propagated from the tefticle
to the loins. Nor do I add any thing farther, though the next fection, of
the Sepulchretum, is entitled de Tejliatlorum Dolore.
For the whole of it, when taken together with the Scholia, fcarcely fills
up two pages : and therein •, to fay nothing of the fourth obfervation, which
perhaps may be an abftract of the firft-, at leaft the fifth* as Bonetus himfelf
confeifes, is taken from the fecond article of the twenty-fecond obfervation,
of the preceding fection : and of the Scholia, which he does not confels,
one part, fubjoin'd to that firft obfervation, had already been adopted by
him-, even where it is mod openly contradictory to the circulation of the
blood ; and applied to article the third, under obfervation the twenty-firft of
the fame preceding fection •, as he alio here fubjoins to obfervation the fe-
cond, a part of the Scholium which he had there fubjoin'd to the twentietli
obfervation.
But there alfo, it is not fo much to be wonder'd at, that what had been
already plac'd under the fecond article of the fifteenth obfervation, mould be
again repeated in obfervation the twenty-third, as that, in one and the fame
page, what had been juft faid in the fecond part of the Scholium, to article
the firft of the twenty-fecond obfervation, mould be repeated in the firft
part of the Scholium to the fecond obfervation.
Nor would I have you fay that many things have, likewife, been repeat-
ed, by me, in this letter, which 1 had already given in others, when relat-
ing my obfervations, or thofe of Valfalva. For it is one thing to repeat what
has been already iufficiently faid ; and another thing lightly to touch upon,
in a brief manner, what has been already deliver'd in other places; in order
to prevent obfervations from being torn piece-meal, and to make them com-
pleat ■, that the circumftances may be confider'd in a more convenient place,
as had often been promis'd there.
This method, as I hope you will approve of it, I (hall preferve^ and the
former, which I have no doubt but you will equally difapprove, I fhall*
without hefitation, reject. Farewell.
(r) N. 38. (/) Obf. ibid. cit. §. 5.1.
\s) Differs ibi cit. §. 30.
LETTER
592 Book IIL Of Difeafe* of the Belly,
LETTER the FORT Y-F OURTR
Treats of the Gonorrhoea.
ALTHOUGH there are, perhaps, few anatomifts by whom fo many
male urethras have been difiected, and accurately examin'd, as byme j
yet it is either much more feldom than is commonly fuppos'd, that very
evident marks appear, in that canal, of difeafes having accompanied the com-
tagious gonorrhoea ; or it has happen'd, by I know not what fatality, that
notwithftanding fo great a number of men is infected with this gonorrhoea)
I never, or fcarcely ever, law thofe evident marks of difeafe.
What happen'd to Valfalva in this refpect I do not know •, for he did not
commit his remarks to writing, if he did chance to find any thing of this
kind, in thofe who had died while they labour'd under this diibrder. What
has happen'd to others I have read*
But what I have feen myfelf, or not feen, 1 will now write to you, in fuch
order, that, beginning from the external orifice of the urethra, 1 mall go on
to the internal orifice which is at the bladder.
2. When, in the Adverfaria (a), I gave my reafons why the firft feat of
the virulent gonorrhoea feem'd, to me, to confift chiefly in thofe larger canali-
culi of the urethra, which I had difcover'd, I did not omit this amono-
others, that from thefe fmall canals, for the moft part, when irritated by the
acquifition of any malignant habit, that humour, which generally diftils from
the urethra, in the firft ftage of this difeafe, might proceed.
For this humour is not true femen, as a comparifon of it therewith, has
fometimes taught even thofe very perfons, who, led afide by a falfe opinion,
often made uie of venery, in order to get rid of the difeafe : and as I have
been thus inform'd, even by the perfons therrtfelves, fo I have often been af-
fur'd by others, that in this firft ftage of the difeafe, there is not, as yet,
any troublefome fenfation in the perinjeum, which mows the diforder to have
descended any deeper.
Nor again, is that which is difcharg'd true pus : as the paiii is not yet of
that kind which argues an erofion ; nor has any even the flighted tincture,
nor the lead drop, of blood ever yet appear'd.
To thefe things I think it would be now proper, to add the obfervations
of that very great man Senac (£), according to which the globules of matter,
{a) IV. Animad. 9.
(b) Traite du Cceur Supplcm. c. 8. n. 5.
that
Letter XL1V. Article 2. $9;
that is difcharg'd in a gonorrhoea, are very large; but the globules which
compofc the pus of* ulcers, are very (mall and unequal ; if they are look'd at
with both the eyes, when furnifh'd with the moll exquilite glades, and are
compar'd with the globules or" the blood.
Following Rondelet therefore in particular; who cautioufly and prudently,
as you have it in the Sepulchretum (c), has laid that this matter " bore a re-
tk (emblance to pus," or ." was fimilar to pus/' I have alio call'd it " puri-
" form."
This fituation of the gonorrhoea in the canaliculi pleas'd feveral authors, I
do not fay Cockburn(V) ; for this author, though in other refpects a learned
man, was even immoderately pleas'd with it-, but 1 fay the great Boerhaave
(e), and the Mutinous Hallt-r (/), who acknowledge " the Teat of the firlt
" ipecies of the gonorrhcea" to be in thefe parts -, and that, by irritation being
at length chang'd into erofion of the corpus fpongiofum urethras, which is
divided from thefe canaliculi only by a membrane, blood itfelf frequently
flows out.
It has alio pleas'd other very learned men, who mark out thefe fmall ca-
nals by the name of cellule miiltiplices: with which, however, I do not very
well understand, how they alio comprehend the gland of Littre ; or how they
can afcribe to him, who never mention'd any thing of canaliculi, the ob-
fervation of thefe being affected in a gonorrhcea •, as if this were read in the
Memoirs of the Royal Academy of Sciences at Paris, for the year 171 1.
But, in regard to the canaliculi of the urethra in women, which were de-
fcrib'd by me (g), in the fame manner as thofe in the urethra of men •, and
in regard to the febaceous glands, which I, in like manner, found in the
nymphs, and the neighbouring labia (h) ; the lait of which go under the very
name of glands, and the former under the appellation of cells •, I will not
fpeak of them here for this realon ; that as I have never happen'd to light on
women, who labour'd under a kind of external gonorrhcea, or were troubled
with an internal, when they died ; I cannot determine whether this latter
has its fituation fometimes in thefe canals, or the former in thofe glands.
Nor have I been more happy in men ; fo as to meet with thole who were
infected with the fame external gonorrhcea, which the phyficians of Mont-
pelier are faid to have formerly call'd " fpurious ;" that I might inquire whe-
ther the matter of this external gonorrhcea came from the furface of the
glans, without being affected with any ulcer, or from the glands of the coro-
na of this glans •, that the opinion of Littre might be confirm'd, who takes
thofe granules of the corona for glands, and not for papillae, as Ruyfch
did (/').
I fay the opinion of Littre •, nor was it ever mine : for when I took notice
of that, I witheld my alfent from both, in order to make a more flrict inqui-
ry •, fo that I cannot help wondering there fhouM be any one, who, after hav-
ing read my firlt (k) and fourth Adverfaria (/;, fhould afcribe the former opi-
(c) Seft. hac 31. 1. 3.inSchol. ad obf. 1. (ti) Adverf.i. n. 11. & 12.
(d) The Symptoms, &c. of a Gonorrhcea, (/) Hift. de l'Acad. R. des Sc. a. 1722. ob£
ch. 4. anat. 4.
(e) Pneleft. ad Inftit. §. 654. (k) N. u.
(/) Not. ;' aJ cum locum, & nota d §. 657. (/) Animad 14. in fin.
(g) Adverf. 4. animad. 24.
Vol. II. 4 G nion
594- Book III. Of Difeafcs of the Belly.
nion to tr.e •, and even fhould aflerr, that a " celebrated controverfy had
" arifen, betwixt Ruyfch and Morgagni," upon this fubject.
For though it is true indeed, that this fell from Ruyfch (»;), that tfr^fe
granules " had been defcrib'd, and delineated, as glands," by me •, yet as I
hop'd that every one would eafily perceive, from my Adverfaria, that this
excellent old man had been fo much taken up with other things, as not fuf-
ficiently to comprehend my opinion, I thought it quite fuperfluous to an-
fwer him, even by a line. And this is the whole of that " celebrated con-
" troverfy."
Much more rare than thefe external gonorrhoeas, is that which the cele-
brated Wolff (») faw and cur'd. For a humour diftill'd from the urethra that
was " analogous to femen •," being at firft white, and after that green ; with
very great pains in making water, and an incurvation of the penis ; and yet
was not the confequence of impure venery, nor of any venery at all ; but
this gonorrhoea proceeded from other cauies that he enumerates : and this is
not only afferted by him, but is fhown by the cure itfelf, as Hippocrates (o)
fays : that is to fay, by the cure being brought on eafily, and ipeedily, by
the adminiftration of fuch remedies, as were oppofite to thefe caufes.
But to pafs over this gonorrhoea, and that which is called Jicca or dry •, or
as it ought properly to be call'd, according to the monitum of the celebrated
Allruc (p), the dry venereal dyfuriaj I muft contract my difcourfe, and come
to that which is the mod frequent, whereof I had begun to treat.
Wherefore, what I had in my power to fee by directions, you will learn
from the obfervations that I fhall immediately fubjoin •, beginning with a
pretty long hiftory, but fuch a one as will be the more pleafing to you, be-
caufe, when I made fome flight mention of the angina, on a former occafion
(q), I greatly complain'd, that, in a very violent diforder of this kind, dif-
fections of fuch perfons who died of it, were Hill wanting.
Therefore, that which was, even then wanting with me, you will here have
in the firft place ; and laft of all, thofe things that relate to the fubjett of
this letter will not be omitted from the fame hiftory.
3. A carpenter, about three and thirty years of age, tall, large in body, and
of a pretty fat habit •, having been, as far as could be learn'd, in good health
before ; being immoderately heated by wine, and by the fire, went home in
the night, in a very cold feafon.
Being there leiz'd with a violent fever, and an angina, a phyfician was fent
for, on the very fame night, and blood was taken from his arm. As the
difeafc did not at all remit, he was brought into the hofpital in the morning :
where the fame remedy was repeated, but with fo little effect, that in the af-
ternoon blood was taken from his foot.
On the next day, when the other remedies ; which had been before given,
internally, to be fwallow'd flowly as well as he could ; and thofe which were
then made ufe of, both internally and externally, had been equally of no ef-
fect ; blood was again taken from his arm in the morning, and at noon from
(w) Thef. anat. 10. n. 98. (0) Sett. 2. aph. 17.
(n) Commerc. Litter, a. 1742. hebd. 47. (p) De Morb. Verier. 1. 3. c. 3.
a- 2. {$) Epift. 14. n. 39.
the
Letter XLIV. Artiele 3. 595
the veins under the tongue : for the jugular could not be open'd, tl
the phyficians wifh'd to have it done, the patient not being able to bear the
lituation requir'd.
After all thefe remedies, the fever and anxiet not only not decreas'd,
but even greatly increas'd •, and with thefe the difficult ^allowing, fpcak-
ing, and breathing, at the fame time; when, on the third day of the dif-
eafe, the patient laying that he had labour'd under a virulent gonorrhoea, for
fifteen, or, at leait, not many" more days, the vein of his foot was again
open'd.
The blood which had been taken away lb many times never had any cruft
on the top-, but was always fomewhat hart), and had very little ferum. His
neck was tumid in fomc meafure ; but not his face, which was not even red.
About two hours after the late venaefection in th.e foot, although the pulle
ftill remain'd ftrong, yet the patient himfelf perceiv'd death to be at hand.
And this did really attack him on the fame third day, about noon-, yet ii
fuch a manner, that it might feem to have come on accidentally.
For having afk'd for the gargle which he made ule of, and, perhaps, in-
cautioufly taken more, into his fauces, than he intended, he immediately
died, in fuch a manner, that they who flood by him, thought him fuftbeated
from thence.
As the day was at hand, on which I was to begin teaching anatomy in the
theatre •, that is, the nineteeth of January, in the year 1 748 •, the body, though
kept two or three days, was, neverthelefs, exceedingly proper for demon-
ftrations ; as the feafon of the year was fo extremely cold, that I could even
make ufe of fome parts of it on the twenty-fixth day after death.
The whole, therefore, being dilTedted accurately, and in order, ofTer'd
fome things to our obfervation, which do not belong to this place j .and thefe
in particular which I fhall give you here, beginning from the parts laft dif-
fered, and going on to the firft.
The vellels of the cerebrum, both external and internal, and not only
within the ventricles, but alfo here and there, through the medullary fub-
ftance, were diftended with blood ; but ftill more they that creep through
the left fide of the pia mater. This membrane, like all the other membranes
of this body, whether you endeavour'd to cut into it, or cut it afunder,
gave more refiftance than ufual. In the lateral ventricles was a fmall quan-
tity of fomewhat-bloody water.
The tongue feem'd to be thicker than is natural : and, at leaft, fhow'd
the vefiels that go upon its upper furface, from the bafis towards the apex,
to be fomewhat thicken'd from the ftagnating blood, not to fay manifeit. The
uvula and the palatum mobile were found.
The tonfils, however, not only had the membrane, with which they are
cover'd, become very thick, from a ftagnation of yellow ferum therein ; fo
as to refemble a kind of yellowifh jelly •, but they alfo were fwell'd, and the
left ftill more than the right, as it was very hard, and, if you prefs'd, or cut
it, difcharg'd pus.
As to the neighbouring larynx, not only the cartilages thereof, but alfo
the proper mufcles, each of which I examin'd feparatcly, were without any
difeafe or inflammation. But there was a dilbrder in the membrane, with
4 G 2 which
596 Book III. Of Difeafes of the Belly.
which the larynx is inverted, both internally and externally : internally the
diforder was flight, but externally very con fiderable.
For internally it was ibmewhat redder than ufual •, as in the neighbouring
bart of the afpera arteria alio •, and ibmewhat fwell'd, but flightly ; lb that the
chinck of the glottis did not feem to be made narrower thereby. But where
the fame membrane clos'd the epiglottis, both on its hollow, and convex,
furface, and even on its fides alfo, it was tumid •, being in fome places of a
bright red colour, and in other places of a bright red degenerating into brown -t
yet lefs on the hollow furface, than elfewhere ; nor on the whole of that, but
only on the upper third part of it.
By cutting into this part, it was plain that this tumour, and colour, were
owing to blood and ferum which diftended nothing but the membrane, and
the glandular bodies that were join'd to it-, a part of which fluids already be-
gan to be converted into pus on the convex furface. Moreover, where the
lame membrane covers the larynx, externally, on the back-part, that mem-
brane, and the glandular bodies, which it envelopes, were affected with a
very confiderable inflammation, efpecially on the fides.
For on each fide it rais'd itfelf up into a protuberance, nearly of the thick-
r.efsofa man's little finger. Thefe protuberances, proceeding from the re-
gion of the bafis of the caitilago cricoides, at its lower parts, and converg-
ing, as they afcended, came fo far, as fomewhat to exceed the height of the
arytenoid cartilages-, being however entirely unconnected with thefe cartilages,
and that upper part of the larynx, though they adher'd to the remaining
and inferior part.
You would have faid that they were two inflam'd condylomata, confidering
their fhape and colour, which was the fame with that I have defcrib'd in the
glottis ; except that, in thefe protuberances, it was more of the bright red,
and lefs of the brown.
But in difiecting them, I faw that they confided of the membrane, with
its glandular bodies, tumid from ftagnating blood and ferum ; and that moft
on the left fide : which fide was moft affected, as I have faid was the cafe in
the tonfils alfo, and the pia mater. Thus you have the beft account I can
give you, of the feat, and nature, of this angina.
In the thorax the lungs were neither turgid nor inflam'd ; but quite found :
although, as I faid of the other membranes, thofe of which thefe vifcera are
conftructed, refifted more than ufual, when cut into, or drawn afunder -, and-
the left lobe had been very clofely connected with the pleura: whereas the
right was quite free and unconnected.
In the pericardium was a little redifh water •, which, certainly, had not been
thus ting'd by blood being mix'd with it in the diffection : for this water was
concreted, by the force of cold, into lamelke, which were internally red.
In the heart, which was preternatural!? enlarg'd, or at leaft feem'd to be
very large, in proportion to the body -, which was itfelf large •, nothing poly-
pous was feen : nor was any appearance of this kind found elfewhere, but a
lmall quantity of black blood, and this neither too fluid, nor concreted.
The large artery had many marks of difeafe, from the valves that are pre-
fix'd to it, which like the other parts of the heart were found almoft quite
to the creliac artery -, and thole very evident. For it- was white here and
5 there^
Letter XLIV. ArtieJe 4. 597
there, internally, with certain (pots, though not very frequent, nor yet verg-
ing to a bony hardnefs.
Internally alio, if you except the places of the fpots, its furface was
fcarccly any where white, but ot a reel colour inclining to brown ; and not
fhining, and fmooth, as it generally, and naturally is, but unequal with cer-
tain fmall, and low excreleences, of the colour that I have already laid, both
internally and externally •, but of a different form and magnitude ; yet lo that
you might cover the largelt of them with a lupin, the figure of which they
nearly refembl'd.
When you look'd on them, you would fuppofe them to be foft •, but when
you cut into them, you would find them to be no lels hard than the paricte;
of the artery. This dilorder was lb much the greater in proportion, the lels
the artery receded from the heart-, yet did not extend itfelf into the carotids
and fubclavians, nor below the casliac : below which, even that firft-men-
tion'd dileafe of the white fpots became much lels and lefs.
Befides thele appearances, all the parietes of the artery were harder than
they naturally are. Finally, the fourth finus of Valfalva was clearly, though
not in any great degree, larger than is natural.
And this I alio obferv'd in the feptum of the venous finufiTes of the heart ;
or, if you pleale, in the feptum of the auricles of the heart: on the furface
which is turn'd towards the pulmonary vein, and comes forwards, it was hol-
low'd out with parallel furrows, which were not very fmall.
In the belly ; the vifcera of which had grown hard from the froft, the bile
itfelf having, in fome meafure, freez'd within its veficle, and the blood itfelf
within the fpleen ; I found nothing that was contrary to the common ap-
pearances of nature, if you except a globule in the mefentery, near to its
edge, that refembl'd nothing more in its form, colour, and magnitude, than
a pretty large boil'd egg: I mean one of thofe which are protuberant in the
ovarium of a hen.
This was nothing but fat, yet of a more yellow colour than the reft, and.
comprehended within. one membrane only, form'd into the ftiape of a fpheri-
cal bladder ; without any membranous lamellae, that could be obferv'd to
run in betwixt.
By reafon of the patient's fpontaneous confeflion, in relation to the gonor-
rhoea, I examin'd the whole of the urethra very accurately. The proltate.
gland might have feem'd to be larger than it ought to be, if it had not been
join'd, as in a large body, with a large penis alio.
This gland was found, the caruncle was found, the veficulas feminales, the.
femen, and the orifices, through which this fluid is exprefs'd from the vefi-
cles, were in a natural ftate. And even our canaliculi fhow'd no peculiar-
appearances ; except that the internal furface of the urethra feem'd to be.
fomewhat moifter, and more red, than ufual.
One of Cowper's glands was wanting, which is a circumftance not very,
rare-, and the iubltance of the other was chang'd into a hard and firm body,,
fo as to referable a ligament.
4. Not to digrefs, then, too far from the fubject of this letter -, I omit;
thofe circumftances relative to the angina, and the peculiar appearances ob--
ferv'd in the aorta : I fay I omit the confideration of thele and other circum-
ftances ij
598 Book III. Of Difeafes of the Belly.
fiances •, and attend only to thofe which have a reference to the go-
norrhoea.
If you let afide the confideration of Cowper's gland being become hard,
which is a circumftance, that, if it relates to the gonorrhoea at all, certainly
does not relate to a recent one, and therefore, of courfe, not to a prefent go-
norrhoea ; you plainly fee that nothing can be refer'd to this, befides the in-
creas'd fecretion of humour in the canals : from whence the furface of the
urethra was very moift, and, from the ftrongly irritating nature of the fame
humour, redder than natural. To this fubjedt may be refer'd what I faw in
another man, when proiecuting a different inquiry.
5. About the end of March, in the year 1741, I diffe&ed, carefully, in
the hofpital, the body of a man, who, having been carried off by an inflam-
mation of the thorax, was a very proper fubjecl for mufcular demonftrations,
and the examination of other parts of that kind.
I made it my bufinefs, then, to inquire into natural, and not preternatural
appearances ; when, being about to infpect the tefticles, in one of which I
found what has been taken notice of in the preceding letter (r), I happen'd to
obferve, that, by comprefllng the glans penis, a little matter came forth from
the orifice of the urethra.
I immediately open'd this canal, in that part which hung on the ontfide of
the body, together with the penis •, fufpecting that the man had labour'd un-
der a gonorrhoea. Yet except a dilute red colour with which the internal fur-
face of that canal was ting'd, and a kind of moifture, greater than natural, I
could not fee any thing that related to this fufpicion.
As I defer'd the direction of the remaining part of the urethra to another
day, I was fo taken up with other obfervations, as frequently happens, that
I forgot to prolecute the prefent, in order to render it compleat.
6. Yet here there had been nothing more than a fufpicion. Attend now
then to what I found when there certainly was a gonorrhoea, though not a
recent one.
7. A young man, of five and twenty years of age, whofe face was of a
yellow colour, had renew'd a virulent gonorrhoea of a long ftanding, by a
more recent one, within fix months. And while this continued, he loft fo
much blood, and fo frequently, from a deep wound inflicted on the left fide
of the neck, that he fell an inevitable facrifice to death, in the beginning of
the year 1 740.
The body being almofl bloodlefs, by reafon of the foregoing hemorrhages •,
and, on that account, very fit for anatomical inquiries ; it was diflected in
the fame place as the former, in the prefence of many auditors, with fo
much the more accuracy, as it had but very few things differing from the
natural ftructure : and theie I will give you the relation of, before I fpeak of
the urethra.
In the lateral ventricles of the brain, together with the plexus choroides,
which, for the reafon I faid before, were pallid, was a little not very limpid
water. The wound of the neck reach'd, in its utmoft bounds, to fbme con-
fiderable branches of blood-veffels, not far from the middle vertebras of the
neck.
(r) Epift. 43. n. 30. & 41.
5 The
Letter XLIV. Article 8.
599
The belly contain'd an indurated liver-, the lobules being very evidently
confpicuous -, and a large fpleen.
\\ hen we came to the genitals •, on infpe&ing the preputium, the glans,
and the whole of the urethra, very attentively, I found no mark of ulcer,
eroiion, or rednefs in any part ; nor any thing elft that related to the prefent
gonorrhoea, if you except a greater moifture than ulual, reaching from the
middle of the urethra, quite to the glans.
But to that old, and long-continu'd gonorrhoea, I fuppos'd thefe things to
relate ; firft:, that, almolt from the place where the moifture began, an ob-
long whitifh line was prominent, tending, obliquely, towards the farther
parts of the urethra : which line 1 have already taken notice of in the forty-
iecond letter (j), and confider'd as the remains of an excrefccnceof flefh, that
had been formerly luxuriant : in the fecond place, although I oblerv'd no-
thing preternatural in the colour, and fubftance, of the proftrate gland, and
the caruncle itfelf-, yet of the orifices, whereby the femen is thrown out into
the urethra, the left was deftroy'd, or at leaft choak'd up and become blind ;
and the right fo narrow, that I could fcarcely fee it, and with difficulty in-
trodue'd a brittle : I alfo found the veficulas feminales fo contracted and
fhrivel'd, that you might fuppoie them to contain nothing-, and this did, in
fact, appear to every-body, whereas, by even preffing them very frequently,
nothing was difcharg'd through that right orifice of which I fpoke juft now ;
yet in the tefticles was found no diforder that was obvious to the i'enies : final-
ly, to omit that there was fcarcely any trace of Cowper's glands -, for they
may, as I have already faid (0, be wanting from the original formation ;
none of my fmall canals, except one that was narrow and fhort, did at all
appear ; fo that I was under a neceffity of accounting for this moifture (which
I have been wont to deduce from thefe chiefly, but not wholly) principally
from thofe very fmall ones, which were known before I difcover'd mine :
neither of which, however, " were formerly well known to Euftachius," al-
though an excellent, and humane young man affirms it, and fays that the
** tables of this author fhow it :" but I take for granted that you will believe
the contrary for a long time, if you continue to give credit to me, till the
numbers of thofe tables, which fhow it, are pointed out.
8. You will perhaps be furpriz'd, that, in the obferVations in queflion,
wherein a gonorrhoea was prefent, no other mark had occur'd to me, that
could be refer'd to the prefent diforder, but a moifture of the urethra, fome-
times join'd with a rednefs-, fince, to omit the obftrvation of Terraneus [u)
of a urethra " being entirely livid from inflammation, and of the difgregated
" glands" therein, which with us are the very fmall canals, " being immo-
■* derately fwell'd •," even in this firft part of the urethra, whereof we fpeak,
Vefalius (x) has afTerted that the fofTbla, or lacuna, which is within the glans»
" is very much infefted with ulcers" in this difeaie ; which is confirm'd by
others alfo, and particularly by the celebrated Aftruc (y), who fays, that in
tiiis foflula u it is found, that very confiderable ulcerations, for the rnoft part,
" are latent."
(s) N.4i.
(t) Aderf. anat. 4. animad. 15.
(u) De Glandul, poft. c. 5. obf. 5.
(V DeCdrp. Hair,. ?abr. f. 5. c. 14.
f. De Morb. Vener. 1. 3. c. j. §. 2.
For
<6oo Book III. Of Difeafes of the Belly.
For this very thing was one of thofe appearances, which I wonder'd had
never occur'd to me •, particularly, as I had fo many times heard the com-
plaints, inpatients or" this kind, of a very fevere pain affecting them, in that
part, " to a remarkable degree, while they difcharge their urine," to ufe the
words of Vefalius ; fince Terraneus (2) does not, as others, and among thefe
Aftruc (rf), make mention of a fharp, and burning pain, " at the time of
'" making water," but even fays, " that it is, for the mod part, icarcely per-
" ceiv'd" at this time: yet that, "when the patient has finihYd to dif-
" charge his urine, there is a violent burning through all the tract of
" the urethra, and particularly where it terminates in the glans."
Which pain, that follows making water, I do not for this reafon diminifh ;
but I fay that I have heard the greateft complaints of that pain which accom-
panies the difcharge, {0 as to have lit on fome perfons, who afHrm'd that they
would not difcharge their urine ; unlefs I could, by fome opportune remedy,
alleviate the torture, wherewith they were, at that time, affected.
And I fatisfied the defires of thefe perfons, not only by diminifhing the ac-
rimony of the urine, as far as poffible, but, particularly, by a method not far
unlike that of Arantius (b) ; who taught thole that were affected with a vio-
lent pain, and forenefs, from the haemorrhoids, how to difcharge their excre-
ments with lefs torture of the inteftines, by fitting upon a clofeftool full of
a hot, oily, and watry fluid ; by the fomentation of which, the anus, not only
when fhut, would be foften'd and relax'd, but foon after, alfo, when open'd
to emit the contents of the inteftines.
That is to fay, I have taught them to let the penis down into a glafs
chamber-pot, half-full of warm milk •, and, after having, by degrees, miti-
gated the pain in fome meafure, by that fomentation, to let their urine come
from them gradually, and without impetus ; (till keeping the penis immers'd
in the milk.
There have been fome, who, when inftead of milk (the ufe of which in this
manner I afterwards faw was taken notice of even by Riolanus (c ), as alfo the
introduction of a fhort leaden or filver pipe, which our Fabricius (d) had in-
vented) •, there have been fome, I fay, who, when inftead of milk, oil recently
exprefs'd from linfeed was at at hand, have chofen to make ufe of this.
And on both fides it is affirm'd, that great advantage has been receiv'd
from thefe applications : thefe laft having added this circumftance alfo, that
when the preputium was tumid and painful,* the pain, and tumour, of that
part had been difiipated in the courfe of one fingle day, by keeping it in this
kind of fomentation.
But this by the way ; which you may render {till more ufeful, by diftin-
guifliing cafes, and boiling ingredients in the milk, fuitable to the particular
cafe. Let us return then to our fubject.
Although Vefalius, and others, have faid what is true ; yet not all gonorr-
hoeas, nor at all times, have the fame acrimony. It has indeed happen'd,
which is a very furprizing thing, that none have ever been met with by me,
(z) Loc. cit. (c) Anthropogr. 1. 2. c. $0.
la) C. cit. §. 3. (</) De Chirurg. oper. ubi de Penis Chir.
(6) De Tumor, p. n. c 60.
in
Letter XLIV. Article 9. 601
in difiecYion, but flight ones ; or that I have met with them only at thrir
mil ler itage. Yet I have often lit on fuch traces, as fufKciently Ihow'd what
injuries 1 ihouki haw found, even in this lirft part of the urethra ; if I had
dilTected theie canals when they were molt affected thereby.
9. For you read jult now (e), that in the young man who had been af-
fected with an inveterate gonorrhoea, no more than one of my canaliculi was
left, and that this was narrow and ll»jrt. No more than one, likewife, ap-
pear'd in a certain porter ; whole cafe (as he fell from a great height, and
died in conlequence of this fall) I fhall defcribe to you when I come to treat
of wounds and blows (f) : and in his urethra, where it correfponded to one
fide of the corona giandis, remain'd fome mark of an old injury.
And you have leen, from the forty-fecond letter (j-), that no more than
one canal was remaining in an old man, who was a foreigner ; whereas the
cicatriz'd ftate of the glans, and the contracted (late of the urethra, plainly
fhov/'d what diiorder had formerly preceded : and you even know from the
lame place (£J, that in a young man, in whom thofe fame tokens were not
wanting, not fo much as one of them remain'd ; to fay nothing of a man,
whom I lhall defcribe hereafter (i).
And nothing is more probable, than that, in confequence of inflamma-
tion, and exulceration, which had, at length, arifen in the fmall canals, the
thin membranous parietes thereof had adher'd to each other; and that the
cavity had, by this means, been intercepted and loft : for that there had been
ulcerations, in that very, part of the urethra, the coarctation of this part,
and even the excrefcence, of luxuriant flefti, in the very feat of the canali-
culi, jointly demonftrated.
But if thele diforders have been violent •, provided they have not been
extremely violent, or not common to all the canals ; either all or fome of them
may remain.
Thus in a certain man, whom I dilTected in the hofpital, about the end of
November, in the year 17 18, having found marks in the beginning of the
urinary paflage, of aforegoing lues ; I faw that fome canals, though but few,
ftill remain'd •, juft as you have read, that, in the butcher (who, as I have
related to you in the eighth letter (k), had fmall ulcers in the preputium,
and cicatrices in the urethra) they were but very few in number : nor have
I menrion'd more than one or two in a gentleman, who had been, more than
once, affected with a lues venerea, as fpokes of in the twenty-eighth let-
ter (I).
But I remember, that they were all ftill remaining, in the ftable-keeper (m)y
whole urethra I, neverthelefs, found unequal with two whitifh lines, at about
the diftance of three fingers breadths from the outermoft orifice ; which, I
take for granted, were the traces of cicatrices and excrefcences.
Yet when they are very attentively examin'd, by any one who is well
vers'd in the ftructure, and appearance, of thefe parts, when in their na-
tural ftate ; I know not what is then fometimes perceiv'd, from whence it
(ej Supra, n. 7. (/) Epift. 50. n. 30.
(f) Epift. S3, n. 37. (*) N. 28.
(g) N. 40. (/) N. 6.
{b) N. 39. (m) Epift. 4. n. 19.
Vol. II. 4 H may
602 Book III. Of Difeafes of the Belly.
may be fuppos'd that they had been, in fome way or other, afFected ; as I
know that it happen'd to me, in the body which I mail fpeak of juft now.
And as, in thofe perfons, in whom all thefe larger canals are obliterated,
it is certain that ib much of the lubricating humour, which ferves to defend
the urethra againft the acrimony of the urine, as they have been the inftru-
ments of its fecretion, muft be wanting ; (o it is agreeable to reafon, that they
muft be, afterwards, more liable than others to a fenfe of ardor, from the
itimulus of the urine, when in a more acrid ftate than ufual •, and even to
erofion, unlefs the whole urethra has grown callous : and that the others, in
proportion to the number of the canals that have been loft, or in proportion
to the injury brought upon thefe canals, are attack'd with uneafineffes of the
fame kind, though fomewhat flighter indeed. But let it be fufficient to
have hinted at this. And let us go on to what I juft now fpoke of.
10. Certain parts of an afthmatic man, who had died in the hofpital,
were brought into the college, when I was teaching anatomy from the body
of another man, in the year 1746. For I like to fhow the fame parts, from
more than one body, when it is in my power; and to fhow them differently
diffected from each other: and this I was then inclin'd to do in the veficulas
feminales, and the penis.
Thefe veficles, although their cells were internally moift, neverthelefs con-
tain'd no femen. The caruncle, and whatever related to the upper part of
the urethra, was in a proper ftate.
But when we were about to cut through the lower part, and had intro-
duc'd a pretty thick probe, through the lower orifice, and open'd the part of
that canal, which is furrounded by the glans ; the furface of which part was
fomewhat unequal ; on attempting to pufh the probe higher up, we found
that it would not pafs for more than an inch and a half.
Then having attempted the fame thing, at the upper part which was
open, we found the fame obftacle, when we came to that part which I have
refer'd to. Opening it therefore, by degrees, on that furface (according to
my cuftom) which is oppofite to my canaliculi, I at length obferv'd thefe
things.
There was a tract of three inches breadth, or more, from which it is was
eafy to fee that the urethra had formerly been ulcerated. For on that fur-
face, in which thefe canals are, were obferv'd three or four whitifh, and al-
moft tendinous, little chords, that pafs tranfverfly, or rather bands, not very
prominent, nor ever feparating themfelves from the internal membrane of
the urethra.
Betwixt chord and chord, there was an interftice ; and then, almoft in the
middle fpace betwixt the firft and laft, the urethra contracted itfelf for about
as great a length, as two fingers breadth would have taken up ■, fo that, in
this part, it v/as narrower, by almoft one half, than it was either above or
below.
Though all thefe things fell within the region of thofe fmall canals, where-
of I am fpeaking, yet they themfelves, and their orifices, feem'd, at firft
fight, not to be in a preternatural ftate.
But when I fix'd my eyes very attentively thereon, and confider'd them
accurately, I was very certain that they did differ from their natural ap-
4 pearance
Letter XLIV. Article n, 12. 603
p arance, in a certain manner, which I can better conceive of, than explain
in words •, lb that it was clear they hail formerly fuffer'd fome injury, though
left than that with which the neighbouring part of* the urethra had been af-
fected.
And this the fituation of the chords, that is of the cicatrices, in that furface
of the urethra only ; I mean betwixt the orifices of the canaliculi ; feem'd to
confirm : as it fhow'd from whence the irritating, and at length ulcerating,
virus had diftill'd.
11. But now let us pafs on to the farther part of the urethra, as I have
promis'd. We alio meet with the feat of a gonorrhoea here, the fecond with
us, the firft with Littre •, that is to fay, as he himfelf has determin'd, Cow-
per's glands : for fo I fliall continue to call them, fince Mery, for I know not
what realbn, feems to have given up his claim, as he filently futTers they
fliould have been fo call'd more than once by Littre, and mown in the Royal
Academy of Sciences (;;) under that name ; and moreover, that in the hiftory
of this Academy (0), the firft difcovery of them fliould have been exprefly
afcrib'd to Cowper.
But how feldom thefe glands are the feat of the gonorrhoea, appears very
clearly from hence, that Littre (p) having dilTected about forty bodies of
perlbns who had been affected with a gonorrhoea, found only one in which
any diforders of thefe glands appear' d : and thefe he defcribes accurately,
and feparately, with all the circumftances which relate to this ipecies of go-
norrhoea ; not even being filent as to the caufe why it is fo rare.
I am lefs furpriz'd, therefore, that I have not lit on the body of a man af-
fected in this manner.
Yet I fuppofe that I have feen marks of this difeafe having formerly pre-
ceded ; either when I have found both thefe glands, or one of them (as in
a carpenter of whom I have fpoken above (q) ) chang'd into a hard fubftance;
for, after inflammation, glands frequently grow hard •, or when I have met
with traces in their duels, not of inflammation only, but alfo of ulceration ;
as in that cafe of which I (hall immediately fpeak.
12. A young man having died in the holpital, about the middle of April,
in the year 171 8, in confequence of a blow on his head ; I diflected the parts
of generation, on the anatomy of which I was then very frequently employ'd,
with accuracy. And I found the other parts, of which I am not about to fpeak,
in a regular and natural ftate.
That the urethra was not in its natural ftate, I immediately apprehended,
when, upon uncovering the glans, I obferv'd a hollow cicatrix thereon. Yet
the proftate gland, Littre's gland, and the femilunar caruncle, fhow'd no
appearance of diforder.
But when I had open'd the remaining part of the urethra, and had feen fome
of the firft of my canaliculi deftroy'd -, for none of their orifices began to ap-
pear, till at about the diftance of four fingers breadth from the extreme part
of the urethra •, examining every thing very attentively, I was ftruck by the
appearance of the ducts of Cowper's gland ; the right of which was thinner
(») Mem. a. 1700. & 1711. . (p) Memor. a. 171 1.
(0) Annor. eorund. (7) N. 5.
4. H 2 than
604 Book III. Of Difeafes of the Belly.
than natural, and the left thicker : as was feen through the internal coat of
the urethra.
Into the thinner duel: I in vain attempted to introduce any thine-, fo that I
fuppos'd the parietes either to have coalefc'd from inflammation, or to have
been contracted to the narrowed degree poflible. The left, on the contrary,
was diftended with a yellowilh and mucous humour ; and feem'd as if it would
readily admit a pretty large probe: and did in fact admit it, but from the
part of the gland ; for the oppofite extremity, that open'd in the urethra, had
a very narrow, and even fo obicure a termination, that I judg'd it to arife
from this caufe, that the duct was fo full of moifture, and the gland belono--
ing thereto thick ; whereas the other was thin, fiender, and contracted.
13. You will here afk, why I conjectur'd that the narrow part of this ex-
tremity might have become thus narrow, from a preceding ulcer. Why I
call'd to mind, that Littre, in the body, in which alone it is faid (r) he had
found this fpecies of gonorrhoea, had never remark'd any ulceration, but
at the edges, and about the edges, of one of the orifices of thofe ducts ; and
that Cowper himlelf, in the explication of that figure (s), wherein he has
delineated both thofe ducts, had taken notice that the orifice of one of them
was very large, " in that fubject, from an ulcer."
And indeed both of them have feen an ulcer at the orifice of the duct-, but
they, or, at leaft, the fecond of them, an ulcer ftill eroding j whereas I, un-
lefs deceiv'd in my conjecture, faw one brought to a cicatrix ; wherefore they
might fee the orifice very open ; and I fuppofe it to have been conftricted
from a cicatrix.
And indeed Terraneus (/) found the orifice quite obftructed, and the
duct furprizingly dilated from thence •, and that on the left fide : in which
fide it happen'd that thofe three obfervators, and I, found the diforders of
the orifice.
14. But going, from thofe orifices, farther into the urethra, we come to
the fecond of the two parts in this canal, in which Vefalius («) has not only
remark'd, that all, who are affected with a gonorrhoea, " feel excruciating
" pain," but has alfo given us the reafon why they feel a pain in this fecond
part, when the penis is erect.
This place anfwers to the lower part of the perinaeum. For there, as by
reafon of the flexure of the canal, its fteep and very low fituation, the corrod-
ing humour ftagnates ; it there alfo erodes (or at leaft irritates) " more than
" in any other part of the canal ; and when the eroded meatus is ftretch'd
** together with the penis, it cannot be but a folution of continuity muft be
" perceiv'd in that part."
And thefe patients are not only heard to complain, at that time, of an un-
eafy fenfation in this part-, but even when, in attempting to expel the lad
drops of urine upwards from thence, they comprefs this part of the meatus,
by means of the mufcles that lie wrap'd around it.
The gland of Littre furrounds this place : and in that place I fuppofe the
urethra to be ulcerated ; fince I have, in that part alio, fometimes feen thofe
(>) Suora, n. 11. (/) De Gland, obf. 6. & fig. i.adD.
(.rj Vid. in Aft. Erud. Lipf. a. 1702. m. (u) C. 14. cic. fupra ad n.'8.
Novembr. ad tab. 8. ng. 1. litt. 11.
4 extuberant
Letter XLIV. Article 15. 605
extuberant lines, which I confidcr as cicatrices ; and as Tcrrancus (x) found
ulcers there from a long-continu'd gonorrhoea.
But thefe things happen only (ometimes. For more generally, I believe
that the irritation, and inflammation, of that part, are fufficient to explain
what Vefalius la\s. Now attend to what I myielf have fecn of this fpecies.
15. A decrcpid old man, who had been feverely afflicted, for many year?,
with a lues venerea •, lb that you could fcarcely underiland what he laid; and
finally had labour'd under a difficulty of making water, and a gonorrhoea,
for twelve years } was gradually walled away by thefe dilorders, and by old
age itfelf j and died before the middle of January, in the year 17 17.
As I differed fome parts of this body in the hoipital, I obferv'd the follow-
ing things, which related to the dilorders in qucftion.
The uvtita, a part of which was wanting, the upper and mod pofterior fur-
face of the t r ue, and the cartilago epiglottis, which had been formerly con-
nected by ligaments, were fo full of cicatrices, that nothing could be more
fo.
Wherefore, that cartilage being unequally contracted, terminated almofl
in a triangular vertex ; being much more fimilar to that of a dog than of
a human creature.
And indeed the diforder propagated itfelf into the remaining part of the
larynx, and the trunk of the afpera arteria, at that part which was nearefl to
it : one of the arytenoid cartillages was luxated as it were ; not being parallel
to its fellow : but within that artery, large and unequal fafciculi of fibres, as
it were protuberated : and on its external furface, at the fpace of two fingers
breadth below the cricoid cartilage, at one fide of the membranous, and muf-
cular interface, a gland was prominent of the bignefs, and fhape, of a vetch,,
and of a cineritious colour; being internally of a red inclining to brown ; that
is to fay, in a round cavity, which was furrounded by white, and not lax
parietes.
This gland I took for one of that great number, there delineated by me
(y) : which, by reafon of the foramen, going to the cavity of the afpera arteria,
being fhut up on account of internal dilorders, had grown out in this man-
ner, and perhaps more fo formerly.
' Before we open'd the belly ; for there was no time to open the cranium,
and thorax ; we obferv'd the mod evident cicatrices from buboes of the
groins. Then letting alone the other vifcera, which feem'd to be in a pretty
natural Hate, we particularly attended to the urinary parts.
The kidnies were very fmall ; and, by realon of hemifpherical protu-
berances, unequal in their furfaces : yet the fubltance thereof fhow'd no dif-
order, except that it was more firm and compact than ufual : although in the
pelvis of one of the kidnies, was a little quantity of whitifh and turbid fe-
rum.
The ureters were much dilated, and were feen to be internally red, almofl
quite to the kidnies: but both thefe marks of difeafe decreas'd, in proportion
as they afcended. In the right ureter, I law the internal coat protuberating,
about the middle of the tube, and doubling itfelf fo as to make an annular
(x) De Glandul. c. 5. & obf. 3. (_>•) Adverf. I. tabi 2. fig. 1.
kind
-6o6 Book III. Of Difcafcs of the Belly.
kind of valve, of a moderate height, which was turn'd againft the courfe of
the urine.
As both of them were half-full of a mucous matter; on their internal fur-
face, from the middle upwards, were prominent, here and there, drops (as
they were to appearance) of a fpherical figure-, ibme larger and fome fmaller;
and having attempted to wipe them away, with the fponge, to no purpofe,
by applying the knife thereto, and comprefling them betwixt my fingers, I
faw them immediately refolv'd into a kind of vilcid humour, which was ting'd,
as it were, with a very dilute colour of tobacco ; fo that after I found hydatids
hanging from the fame coat, as I have already written to you (z), I fuppofs'd
thefe drops, that I am fpeaking of, to have been of the fame kind.
Moreover, the bladder, confuting of very thick coats, through the inter-
nal furface of which a kind of thick fafciculi of fibres were feen, join'd to-
gether by a various kind of intanglement, overflow'd with a white and tur-
bid humour. Then, beginning the incifion of the urethra, from the glans ;
one fide of the corona whereof had been formerly corroded by an ulcer; I
fcarcely found any thing worthy of remark, till I came to Littre's gland.
This part was, internally, cover'd over with very thick fanguiferous vefiels,
fo as to be far more red, than black, as it ufually is. And the proftate gland
offer'cl no appearance that deferv'd great attention, befides three very fhort
and fuperficial finuffes, which contracted themfelves, from a pretty large
orifice, into the form of a cone ; and were fituated betwixt the feminal ca-
runcle, which was in its natural ftate, and the orifice of the bladder, accord-
ing to the length of the urethra.
1 6. In this body alone, do I remember to have feen the urethra thus af-
fected, in the perinasum : to which affection, however, fome caufe might be
afforded, even by a part of the urine ftagnating there ; efpecially in a de-
crepid old age, and when the urine itfelf was not in a natural ftate.
At leaft this kind of affection was not found in the many others, whom I
have defcrib'd, as having been affected with a gonorrhoea ; and not only in
this letter, but in others alfo ; and particularly in a certain fervant (a) of a
miller, who dying at the time of being afflicted with a gonorrhoea ; muft have
had fome mark of difeafe, in the pendulous part of the urethra, which was
not allow'd to be dilTected ; fince in the upper part of this canal he had no
more than the many others, any mark of difeafe in any part.
How did it happen then, you will fay, to be aflerted, with one common
voice as it were, that there was a diforder in the proftate gland, and the fe-
minal caruncle.
Without doubt becaufe, as they did not doubt, at that time, but the hu-
mour which drips down in a gonorrhoea, if legitimate, is uninfected femen,
fo they did not doubt, if the gonorrhoea was a fpurious one, but the dis-
charge was of femen contaminated with the venereal miafmata.
But afterwards, fome of the phyficians began to fufpect, that what flows
from the urethra, in a legitimate gonorrhoea, is not always real femen ; as
ihey faw that many did not grow fo thin, and become enervated, as they
muft in courfe have done, from fo great a quantity of humour being dif-
[z) Epift. 42. n. j 1. («) Epift. 24. n. 18.
charg'd,
Letter XLIV. Article 17. 607
charg'd, and for fo many years together, as frequently happens, if it were
real lemen.
And indeed, we fee into what an emaciated (late, and dejection of ftrength,
they fall, whodilcharge the femen, in confequence of lafcivious dreams, very
often, and for a long time together. Some of thefe perfon , I have known, who
having receiv'd no advantage from remedies, and fearing left they fhould be
hurried into a fatal atrophy, determin'd, by a kind of happy thought, to tie
the penis round about with a band of foft leather, under the very margin of
the corona glandis ; lb that, as long as the penis did not become rigid, they
fhould feel no inconvenience from it-, but when it began to grow rigid, that
it fhould immediately create an uneafinefs, and the danger of emitting the
femen be remov'd, by being rous'd from their deep.
Moreover, Boerhaave proceeded much farther than the fufpicions of thefe
phyficians led him, as he exprefly denied {b) that he had ever known true fe-
men to be difcharg'd without a venereal tentigo, either fleeping or waking ,
fo that it muft be a very extraordinary difeafe indeed, wherein this fluid is
fpontaneoufly difcharg'd, and without any fenfation.
He therefore judged the difcharge to proceed from the proftate gland.
However, I do not fay thefe things, becaufe I believe that true femen is
never difcharg'd without venereal cogitations. For I believe, that, where the
edges of the fmall foramina, through which the femen defcends into the ure-
thra, are eroded, or very lax ; or where the femen itfelf is very watry ; it may
flow down without any lafcivious idea •, as happens to fome from the injection
of a pretty warm glyfter, or from difcharging the inteftinal feces when very
hard : except, in the former, that which is difcharg'd is always in fuch a
fmall quantity and of fuch a kind that it is not abfurd to account for it from
the proftate gland, by reafon of its peculiar nature, and being always in fmall*
quantity •, and in the latter it can never be from the veficulas feminales.
But as I know that this does not happen on every occafion, as was formerly
fuppos'd, fo that it does happen fometimes, is out of my power to deny.
17. We are come, as you fee, to the laft feat of the gonorrhoea in the ure-
thra-, I mean the proftate gland, and the feminal caruncle. And if the latter
of thofe parts always fhow'd the feminal foramina to be very open, at that,
time, either by means of laxity or erofion •, or if the former were fo ulcerated
in all perfons, that the ulcer reach'd to the feminal canals, which pafs thro'
that gland ■, there would be no reafon why we fhould deny, that a flux of real
femen muft of courfe happen.
But in many there is nothing of this kind ; as not only what I have hitherto
written, in this letter, fufficiently fhows, almoft in general, but the obferva-
tions of others, amongft whom is Terraneus (<:)>' and Blancardus, whom he
quotes, confirm ; but in particular Littre (d), who, from his own inflections,
has determin'd the three feats of the gonorrhoea, in each of which the diforder
fometimes is, without affecting the two others : and of the three he holds one
to be the proftate giand : after this he fhows that when the feat of it was in
Cowper's glands, the proftate was not affected ; and demonltrates with what
(l) Pnelea. ad Inftitut §. 776. (</) Mem. de l'Acad. R. des Sc. a. 17 1 1.
(c) De Grand, c. 5. obf. 3. & feq.
difficulty
6o3 Book III. Of Difeafcs of the Belly.
difBcuky the virus can be propagated into this gland, or into the caruncle
from thence.
But aotwithftanding the truth of thefe things •, it cannot however be de-
nied, that, in others, nevenhelefs, (as, for inftancc, in mod of thpfe per-
fons who are troubled with a very virulent, and obftinate gonorrhoea) a dif-
order has been tound in the proftate, and the caruncle.
For to take no notice of what is faid by Wharton (e), that the fmall excre-
tory foramina of the proftate gland, which in healthy perfons are not confpi-
cuous, " are very evidently diftinguifh'd in them ;" obfervations are pub-
lifh'd, and even extant in the Sepulchretum (f)> by Bartholin, Severinus,
and Wirlungius, of the fame gland being ulcerated, or affected with an ab-
fcefs in a gonorrhoea ; and after a gonorrhoea, of its being cicatris'd : and you
likewife read there (£), that Guenotius defpaii'd of a cure in that difeafe,
when, by introducing his finger into the anus, he perceiv'd a refilling tumour
of this gland.
Nor are more recent obfervations wanting, of this gland being vitiated
from a gonorrhoea. Two of which, in particular, it may be proper to pro-
duce, the one of Brunnerus (£), and the other of Genfelius (i).
For thefe authors, although they differ'd from each other fo much, in re-
gard to caruncles growing out in the urethra, that the firft of them faid
thefe were nothing more than the figment of the furgeons ; as he had ob-
ferv'd in a certain perfon, that the impediment to the catheter's introduction,,
had not been from a caruncle, which did not exift, but from " a remarkable
" ftricture, and coarctation, or rather aduftion," of the urethra ; almoft as I
have defcrib'd above (k) in the afthmatic man ; and Genfelius, who, in an-
other body, had feen a caruncle of this kind, but no coarctation, contended
for thefe caruncles : at the fame time then, that they difagreed about thefe
points, they perfectly agreed in this, that the fecond, in his patient who had
been affected with a recent gonorrhoea, after labouring under a virulent one
for fome time before, had found " feveral little ulcers about the proftate •"
and the firft in his, befides " a very great ftridture of the meatus," in that
part alio, had feen " the furface thereof, about the proltates, very evidently
" mark'd with cicatrices, from old and inveterate ulcers, which were then
« heal'd."
But as to what relates to the feminal caruncle itfelf, you have it, not only
in the Sepulchretum (7), that Vefalius, in this city, found both the extremi-
ties of the veflels, that carry down the femen, and lie on the fides of the ca-
runcle, fo as in fome meafure to efcape the fight in other bodies, to be
" open and lax," in a certain man who had labour'd under this difeafe ; but
you read alfo in the celebrated Benevoli (?»)> both an obfervation of his own,
on a man, who had been afflicted with the fame difeafe, almoft two and
twenty years, in whom was a large and callous ulcer, lying hid in the proftate
gland in fuch a manner, that it only emitted the pus by the caruncle -t which
(<?) Adenogr. c. 31. (/') Earund. cent. 6. obf. 84.
(/) Seft. hac 31. obf. 5. §. 1 & 2. (*) N. 10.
(g) In Schol. ad obf. 4. (I) Se6t. cit. obf. 2.
(/j) Eph. n. c. cent. 1. obf. 97. (;;;) Propofiz. int. alia Canine, c. 3.
was
Letter XLIV. Article 18, 19. 609
was likewife eroded internally by the ulcer; and other obfervations («) of the
lame caruncle being ulcerated in a gonorrhoea, that are taken notice of from
Genga.
And the caruncle you know is fo fmall, that there can fcarcely be an ulcer
in it, but it mult corrode the extremity of both, or at lead of one of the fe-
minal canals •, and by this means open a paflage, for that fluid to be continu-
ally diltilling down, even more than when the orifices of the fame canals are
too lax, and open.
However, the ulcers that are in the proftate gland do not all do this ; but
cn!y thofe which are in that part of it, through which one, or both, of thefe
canals are carried ; and this part is the higheft behind the urethra: but when
ulcerous linuflcs are brought on from thence, they open a paflage for them-
felves, for pus, and for femen, into the internal furtace of the urethra-, or,
on the contrary, by winding, and creeping, they reach from this internal fur-
face, quite to thofe canals.
Other ulcers of this gland difcharge their pus, mix'd together with the hu-
mour fecreted therein ; euher through the proper orifices of the ulcers them-
lelves, which may lie open within the urethra, or through the natural orifices
of the fame gland : through which, when they are only very lax, and not af-
fected by an ulcer, this humour alone, and not either pus, or femen, is dif-
charg'd.
And thefe things I have hinted, that it might be underftood, to what clafs
thofe traces of old difeafes, which I have happen'd to fee, either in that gland,
or in the caruncle, or in both of them, are to be referr'd ; and this even
though I (hould be filent upon the fubject.
18. And in the firft place, I have found fuperficial traces ; as, for inftance,
thofe whitifh and protuberant lines, the remains, as I fuppofe, ofexcrefcen-
ces ; or thole three very fhort finufles, which I defcrib'd above (0), in the de-
crepid old man : but others I have met with that were deep, and quite hid-
den ; as you will learn from the following hiftory.
19. In the year 1742, when I began the public demonstrations of anatomy,
I made ule of the body of an old man, whofe diforders I could not get any
certain information of •, for which reafon I lhall tell you the more briefly,
what preternatural appearances I met with.
The thorax contain'd a heart which was enlarg'd, and had the parietes
thicken'd : the beginning of the large artery was wider than it naturally is,
and internally diftinguifli'd with very frequent white fpots, of a tendinous
nature as it were, not to fay bony.
And the belly, which had been previously examin'd, exhibited the fame
kind of fpots in the fame artery, as it pafs'd through that cavity •, though lefs
considerable than in the thorax ; if you except one very hard fpot, which was
at the orifice of the arteria facra, and feem'd to have render'd this orifice
more contracted than the trunk was in proportion.
But as I have already taken occafion to tell you, in the twenty-ninth let-
ter (p), what preternatural bodies were feated upon the ring of the pylorus,
(«) C. 5. ^) n. 17.
Co J N. ,s.
Vol. II. 4 I m-
6 io Book III. Of Difeafes of the Belly.
or what glands were prominent in the antrum pylori, there is no reafon why I
fhould repeat the relation here.
The liver, upon its convex furface, was almoft univerfally become united
to the diaphragm. The fpleen was thicker than ufual, and wider ; being in-
ternally of a dilute fcarlet colour: the arterial branches, which enter'd it,
were themfelves tortuous indeed, but the trunk of the fplcnic artery, from
whence they came, was, contrary to the ufual cuftom of nature, not at all
reflected, or tortuous, in the whole of its courfe.
The kidnies were longer, in proportion to their breadth, than they natu-
rally are. The coats of the bladder were much thicken'd.
Finally, the proftate gland, where it poffeffes the anterior part of the ure-
thra, had a cavity, entirely included within its iubftance, of the figure and
magnitude of a middle-fiz'd grape ; the parietes of which, being of the fame
colour with the reft of the gland, feem'd to be inverted with a kind of thin
membrane, as if it were the follicle of the tumour : but within thefe parietes
nothing was contain'd.
20. As it was not at all clear, what had been formerly comprehended in
this cavity, and how it had afterwards been remov'd ; it brought to my mind
what I had feen, a year before, in another old man, of whom I fhall fpeak
of to you (q), when on the fubject. of fevers.
That is to fay, in the proftate gland, which was enlarg'd, and, in its ex-
ternal circumference, of a red colour inclining to brown, I found within the
remaining part of its fubftance •, which was in other refpects in a natural ftate ;
granules of tobacco as it were, of a yellowifh colour inclining to blacknefs ;
and thofe in feveral places.
Thefe appearances were not far from the internal furface of the urethra ;
fome lying fcatter'd up and down at a considerable diftance from each other,
and fome being crowded together into one cavity, much lefs than that where-
of I juft now fpoke.
Shall we then fuppofe this larger cavity alfo, to have been, at one time or
other, fill'd with granules of this kind ? But of what nature are thefe gra-
nules ? For I have found them in many bodies, and not then for the firft
time.
In the Adverfaria (r), I confider'd them as a humour which is fecreted in
the proftate, and coagulated into that form : nor do 1 at prefent fee any rea-
fon why I fhould not confider them in the fame point of view alfo.
Yet what can be the caufe, from whence this humour changes its form
and colour in fuch a manner, whether from the lues venerea having formerly
preceded, or any other kind of diforder, I leave quite undetermin'd ; as I
likewife do that fufpicion, whereof I gave a hint in a former letter (j), I mean
whether thefe granules may not fometimes be the matter of the calculi, that
are found in this gland.
Yet I never met with a larger quantity of thofe granules within this gland,
than in the potter •, as you will readily perceive by reading over again my
feventh letter (/) : and, in regard to him, you will confider whether you may
(7) Epift. 49. n. 18. (t) Epift. 42. n. 37. in fine,
(r) IV. Animad. 14. (/) N. n.
afcribe
Letter XL IV. Article 21, 22. 611
afcribe them to an old lues venerea, that had preceded, by reafon of no frae-
nulum remaining at the glans, nor any traces of it-, as you alio will, in re-
gard to the old man, whole hiitory is given in the twenty-fourth letter (u)y
in whom no more than one or the larger canalieuli of the urethra remain'd .;
and that in a (lender ftate •, at the fame time that theft granules were not
wanting at the fides of the feminal caruncles.
I am inclin'd to add two other examples, in this place, from the bodies of
men : and though I am almoft altogether ignorant what difordcrs they had
been affected with, yet I fhall not fcruple to relate what preternatural appear-
ances they had in the other parts of the body alibi for I do not think it quite
without its utility, as you have feen elfewhere alio, to take notice of preter-
natural appearances ; that by comparing them together with accuracy, it
may, at lealt, be known, what marks of difeai'e occur more frequently, or
more rarely, in certain ages and habits of body.
21. The body of a man, of four and fifty years of age, who had been
gradually carried off by an apoplectic diforder, was given to the college in
the year 1728 ; to begin the public demonftrations from •, till an opportunity
of getting better bodies fhould offer itfelf. For which reafon the head was not
touch'd. What was found in the belly, and in the thorax in part alfo, that
deferv'd notice, I fhall obferve at prefent.
The inteftines were lax, and in a manner inflam'd : yet neither thefe, nor
the ftomach, had any mark of erofion ; fo that fome recent caufe might be
fuppos'd to have occafion'd that appearance which I fhall defcribe in the duo-
denum •, efpecially as pus, putrid fmell, a thicknefs and inequality of the
lips, and all other marks of ulceration, were wanting.
At the diftance of two fingers breadths below the pylorus, was a place, in
which the internal coats of the inteftines were wanting ; and thus an orifice
capable of admitting a finger was form'd : and a finger being introdue'd into
this orifice, the moft external coat of all, which eafily gave way in the out-
ward direction, was form'd into .a kind of diverticulum as it were .
The ipleen was found ; but much lefs than it ought to be, and in every
refpect very fmall. The trunk of the great artery had, internally, in that
part where it adher'd to the vertebras of the loins, fome confiderable bony
fcales : yet the fame veffel was very found within the thorax ; as the heart
was alio.
The urinary bladder was lefs than it ought to have been, in proportion
to the fize of the body. In the urethra was nothing particular obferv'd -,
except granules of tobacco as it were, at the orifices of the proftate gland.
22. As to the other man, who was fomewhat younger than the former, I
have already faid, by the way, what his habit of body was j and of what difor-
der he died ; when I was fpeaking of his haemorrhoids, in the thirty-fecond
letter (x) : fo that it will be fufficient to add here, what I faw in the upper
part of the urethra.
The feminal caruncle had, at the fides of it, granules of the kind I am
fpeaking of; from fome of which, that were diffolv'd, as I iuppole, by the
(«) N. 6. (x) N. 10. in fine.
4 I 2 moifture
612 Book III. Of Difeafes of the Belly.
moifture of the place, not only the other parts, which lay near, but even the
orifices of the feminal duels, were yellow.
I obferv'd at the fame time, that thefe orifices were much larger than they
us'd to be ; and of an ellyptical figure. And one of them was a little larger
than the other.
23. Now as we have begun to treat of the diforders of the caruncle itfelf,
I might; if I had not had occafion already of doing it above (y), or in a for-
mer letter (2) •, give you the relation of other diforders, of the two orifices
that are therein, of a contrary nature to thofe which are juft now fpoken of;
I mean that I faw one of them much narrower than it generally is, and the
other quite fhut up : and even that it was not in my power to diftinguifh,
and demonftrate, either of them ; nor even that larger orifice of the finus
which lies betwixt them, by reafon of the caruncles being defae'd by an old
lues venerea.
Now then you have my obfervations, from one extremity of the urethra to
the other, according to my promife in the beginning : and fuch as they are,
you are at liberty to make what ufe you pleafe of them •, as they not only
relate to thofe who actually labour'd under a gonorrhoea at that time, or had
formerly been afflicted with it, but even to thofe who might feem to have been
affected therewith (*).
24. It does not efcape me, that other feats have been affign'd to this dif-
'order, even on the outfide of the urethra, and the glands that lie very near
thereto •, that is to fay, in the veficulae feminales, in the teftes, and even in
the urinary bladder and kidnies. Each of which fuppofitions I fhall touch
upon flightly, and then put the fihifhing hand to this letter.
25. In regard to the veficulae feminales, befides the opinion of the older
authors-, and among thefe of Riolanus, who is quoted in the Sepulchretum
(a) ; we fhould have obfervations of Littre, if he had executed what he pro-
mis'd (b)i when he treated of the gonorrhoea of Cowper's glands.
However, it is eafy to conceive, that, when the feminal canals, which go
through the proftate gland, and open in the caruncle, are eroded, the difor-
der may be eafily communicated to the veficles.
A proof of this circumftance was perhaps offer'd to me, at the time, when,
in a young man of five and twenty years of age (c), I found the veficles fo
contracted, and without moifture, contrary to the general habit of that fea-
fon of life ; for the fame virulent inflammation, which had formerly con-
tracted the extremity of one of the feminal ducts, and had fhut up the other,
might be propagated into the veficles, and deflroy them.
Yet I would not have you fuppofe, as often as ever it happens, to any
perfon labouring under a long, and terrible gonorrhoea, to emit a bloody
iemen in confequence of lafcivious dreams, or a femen that is foetid and con-
taminated with fordes and pus ; I would not have you, I fay, fuppofe in thefe
cafes, that the diforder is neceffarily propagated to the veficles : for it is pof-
fible that purulent, and foetid fordes, and a fmall quantity of blood, may be
(y) N.J.
(z) Epift. 40. n. 29.
(•) Vid. etiam Epiit. 60. n.
12.
(a) Sett, hac in Schol. ad obf. 4.
(b) Mem. del'Acad. R. des Sc. a.
(<-) Supra a. 7.
1711.
fwept
Letter XLIV. Article 26. 613
Avept away, and carried down, from ulcers that occupy the urethra, the
proftate gland, and icminal caruncle, by the ejaculated iemen, which is in
other refpedts found.
For it does not always, and of courfe, follow, that the diforder is com-
municated to the veficles, even from the ulcers of thole neighbouring and
laft-mention'd parts ; notwithstanding I have faid that it may be communi-
cated without difficulty.
26. But is the tranfition of this difeafe, from the veficles into the tefte*,
equally eafy ?
That the virulent matter regurgitates from the veficles into the tefticles, that
thefe glands become tumid thereby, and are in part the feat of the gonorrhoea,
when the dilcharge of the matter is prevented by the force of aflringent
remedies, Wharton has taught us (d) -, for the words of this author are, al-
though this is not very clearly fhown in the Sepulchretum (e), nearly what
de Graaf (f) has not only follow'd, but copied-, even at the time, when, to
confirm this, he fays that the gonorrhoea of women, " without doubt, pro-
" ceeds from their teftes," as they have no proftates.
Yet de Graaf mull, of courfe, have rejected this confirmation afterwards^),
when he aiferted that women not only have proftates, but are without any-
fluid femen in their tefticles.
But if Wharton, or de Graaf, at the time when he follow'd the opinion of
Wharton, had call'd to mind the obfervation of Panarolus (7>); who fays that in
a woman, who died after a continual gonorrhoea, " a vomica was alio found
" in one of the teftes •" they would, perhaps, have drawn an argument from
hence, in favour of this their opinion ; but a very weak one -, fince Panarolus
has not entitled that obfervation (/'), which is not accurately copied, as Bo-
nerus has done, by prefixing thefe words, " a gonorrhoea generated in a wo-
" man by a vomica in one of her teftes j" but has given quite a different view
of it, by faying, " a vomica in the teftes of a woman, from an old go-
norrhoea."
For there is no doubt, .but the venereal virus may be carried, from the
feat of an old, and long-continued gonorrhoea, into the ovaria alfo •, as well
as into other parts -, after it has been abforb'd by the lymphs-ducts, or
by the fanguiferous veffels, and has infected the whole mafs of blood : nor
does that paflage from the vagina, through the hypogaftric arteries, to the
ovaria, which has been thought of by Vercelloni (£), pleafe me any better
than many other things which we read in his work ; as if the arteries receiv'd
any thing, from the parts near to which they pafs, to tranfmit to fome dif-
tant parts.
The feat of the gonorrhoea, then, is not to be fuppos'd in the tefticles of
women, from the obfervation of Panarolus.
But muft we not, at leaft, allow it to have a feat in the tefticles of
men ?
(d) Adenogr. c. 31. [h) Pentec. 1. obf. 14.
\e) Seft. hac Schol. 2. ad obf. 5. (i) b. in fed. hac.
(/) Ibid. Schol. ult. ad obf. 1. \k) De Morb. Pudend. c. 3. $. 3.
{g) De Mulier. Organ. Generat. c. 6. in
ine.
Wc
6 14 Book III. Of Difeafes of the Belly.
We may allow of it with fomewhat lefs difficulty ; fuppofing it be con-
firm'd however, by other obfervations, befides that of the tumour of thefe
parts, when the dilcharge of a gonorrhoea is fupprefs'd by aftringents.
For it is by no means necefTary, if the tumour of a part follow the violent
and fudden iupprcffion of any difcharge, to have immediate recourfe to this
iuppofition ; that the matter had before flow'd from the now tumid part, or
has, at prefent, regurgitated into it.
Yet that, by the improper ufe of aftringents, the irritation and inflam-
mation may be increas'd, and propagated from the upper part of the urethra,
and the adjoining veficles, by the vafa deferentia, to the tefticles, and that
this may be fo much the more eafily, and fpeedily produc'd, alfo, to fuch a
degree, as the pafTage of the femen betwixt thefe vefTels, and the tefticles, is
almoft intercepted, and by this fluid, which is, confequently, retarded in its
courfe, the tefticles are diftended •, and finally, that the matter, which was
difcharg'd by the urethra, may enter the general channel of the blood, and
be carried therewith into the tefticles ; we do not deny.
But you fee that there is one of thefe methods, I mean the fecond, by -*£
which you may conceive of the tefticles being tumid, and yet not infected
with a venereal contagion ; and confequently not become the feat of the vi-
rulent gonorrhoea.
27. And the pafTage from the urethra to the kidnies, is not a little longer
than to the tefticles: and yet, that the diforder, if it is continued for a very
long time, may creep to a diftance from the urethra, " and infect the bladder
" and ureters, and at length even the kidnies themfelves," is affirm'd by Do-
donseus (I).
For I haveobferv'd, that they are the words of this author, which you will
read in the firft part of the Scholium, to the fourth obfervation, of this thirty-
firft fection of the Sepulchretum, which is taken from Dodonasus himfelf;
but neither there, nor in the title to which we are refer'd, D.J Hypogaftrii Do-
loribus^ that is in the twenty-third fection, where it is given under obfervation
the fixth, article the fourth, is it wholly copied : fince neither in one place,
nor the other, mention is made of the whole urethra being ulcerated, and
fill'd with coagulated blood.
But that the diforder fhould creep fo far as to the kidnies, " a long con-
•' tinuance" is, as you fee, requir'd by Dodonreus •, and the gonorrhoea,
which is fpoken of in that obfervation, had lafted eighteen years.
However, in what manner, where the bladder is ulcerated, the diforder
may be communicated ftill much fooner, by the urine, to the ureters, and
kidnies •, I have already fhown in a former letter (m) : from which place you
might prudently feleci fome things as joint caufes, if there were any occafion,
and accommodate them to this obfervation of Dodonzeus; not to mention
three of mine which are not far unlike it.
For, in fo long-continued, and fo fevere a gonorrhoea, what adyfuria, and
what a ftrangury, there muft have been ibmetimes, is Sufficiently apparent j
and the bladder being plane rigida, quite rigid (not plane frigi 'da, quiee cold,
(/) Medic. Obfervat. c. 41. (*) Supra, n. 15. & EpLt. IV. n. 19. &
(m) 42.11. 23. XL1I. n. 40.
as,
Letter XLV. Article i. 615
as, by a typographical error, it is mofr. ftupidly perverted in the Sepulchrc-
tum) " could neither be diftended nor contracted."
But that the kidnies may be vitiated from long and repeated gonorrhoeas,
without the bladder's being affected, appears very clearly, and evidently ;
even from that hiftory of Valfalva, which I gave you in the beginning of the
fame letter (o) •, the diforder, conlequently, not creeping on from the ure-
thra, but entering into the paflages of the blood, and palling on, through
thole, to the kidnies.
However, be this as it will ; I fhall not fuppofe the bladder, the ureters,
and the kidnies, to be the feat of the gonorrhoea for that reafon •, not only
becaufe no femen, nor fluid relating thereto, flows down from thofe parts ;
but alio becaufe an ichor diftilling therefrom, cannot, unlefs the fphincler of
the bladder happens to be injur'd, come, at any time, into the urethra, by
drops, without urine, and bely a gonorrhoea. But it is time to conclude.
Farewell.
(*)N.
z.
LETTER the FORTY-FIFTH
Treats of the Defcent of the Uterus, and likewife of
the Afcent, as Women call it.
WHAT Hippocrates has laid (a); that "the uterus, when mov'd
" out of its natural fituation, to any other part, brings on difeafes,
" whether it proceed outwards, or be retracted internally ■" will be the fub-
je£t of this letter, which will anfwer to the two next fe&ions of the Sepul-
chretum ; that is, to the thirty-fecond, De Uteri Procidentia Defcenfu & cat.
and the thirty-third, De Hyjlericis Affetlibus, Suffocatione & cat.
For I thought it proper, to comprife thefe two fpecies of diforder in this
one letter, left it fhould, perhaps, be too fhort \ fince Valfalva has left no
difle&ions, which relate to thele diforders, and I have very few : I hope,
however, you will receive thefe, fuch as they are, with a willing and atten-
tive mind, as you have receiv'd thofe that I have fent you hitherto.
2. Firft then, in refpect to the prolapfus, or defcent, of the uterus, you
know very well that, with Fernelius (£), there was then a defcent of the ute-
(«) Deloc. in horn, n. 59. (i) Pathol. 1. 6. c, 16.
rus,
2
616 Book HI. Of Difeafes of the Belly.
rus, when it had fallen downwards, though it had not yet fallen outwards;
and a prolapfus, when it is inverted and thrown out of the body •, which can
happen only from the great violence of labour-pains : except that it may
fometimes, alfo, happen, from the rafhnefs of an imprudent midwife, who
takes away the fecundines with violence.
And he would have treated of the fubjecl: fully, if he had not omitted an-
other kind of prolapfus •, I mean that kind in which the uterus does not in-
vert itfelf, but being fhut up within the inverted vagina, is prolaps'd out-
wards.
For in the defcent of the uterus alfo, the vagina muft of courfe invert it-
felf, in the fame proportion as the uterus defcends. And this part inverts
itfelf, from the fame external, or internal caufes, that give occafion to the
defcent of the uterus; that is to fay, thofe which at the fame time diftend,
or relax the ligaments of both thefe parts, and among thefe caufes, how we
may reckon the uterus itfelf, and the vagina, I mall fhow you below (c).
Befides thefe true defcents, or prolapfes, of the uterus, there is alfo a pro-
lapfus of the vagina ; not only the more flight, but fometimes fo great a
one, and of fuch a kind, that it may be taken for the prolapfus uteri, which
I took notice of in the fecond place •, one of which kind you will fee defcrib'd,
and reprefented in a plate, by Jo. Gulielmus Widmannus (d); who found it
to be made up only of the internal coat of the vagina.
3. All thefe fpecies of diforder we, alfo, allow to have been taken notice
of by the ancient phyficians ; and even by their mod ancient mafter Hippo-
crates,; if , you except that kind of prolapfus, in which the uterus inverts it-
felf.
Yet that this was hinted at by Celfus (e), I think I have fufficiently fhown
in my fourth epiftle upon him. And that, in the books of Hippocrates, not
only the prolapfus vaginas is taken notice of, under the title of " the uterus
•*' falling outwards (/)," the cure itfelf (hows ; but alfo, that the true defcent
of the uterus, and the fecond kind of prolapfe, are taken notice of, the fol-
lowing words fhow : " but if the uterus is very near to the external parts"
(£), and " if the uterus falls quite out of the pudendum ; it hangs down like
" a fcrotum (b) : but if the os uteri fall down on the ouriide of the puden-
44 dum, & cast." {i).
As almoft ail thefe things were juftly, and defervedly, preferv'd by their
defcendants, without any doubt, down fo low as the remembrance of our
fathers ; and as even many perfons, fome at one time and fome at another,
had not doubted that the uterus, when prolaps'd, has been extirpated, with-
out deftroying the woman ; and that not very feldom neither, though, to con-
fefs the truih, with too great a credulity; not to fay any thing of thofe who
had gone fo far, as to contend, that children, by the fpecial grace of God,
had been procreated by thefe women afterwards ; there arole at length, as
you will learn from the Sepulchretum, fome men fkilful in anatomy, and
iurgery ; who, although they, with great juftice, argued againft the exceflive
-(c) N. 12.
(d) Eph. n. c. cent. 8. obf. 98.
(e) De Medic in Prsefat.
Xf) De Exfett. feet. n. 4.
(g) De Morb. Muliebr. 1.
(%) Ibid. n. 38.
CO Ib- n- 39-
2. n.
37-
credulity
Letter XL V. Article 4. 617
Credulity of others, yet did not run counter to it with the greatefl. prop;
as they not only granted fome things, which they ought not to have granted,
but, moreover, even denied thole very ancient, and lbund dogmata, relative
to the prohplus uteri ; and what is it ill more furprizing, made fome cele-
brated mailers in both thele faculties, and in medicine, their follower;,
(ectaries.
4. For that the uterus has been, fometimes, really cut our, " in an cxtn-
" ordinary and very rare cafe," yet that the woman has furviv'd, why fhould
we not rather fay with Georgius Wolflg. Wedelius (k)t than that it never h .->
been, with Jo. Guilielmus I'auli (/), who treats of this fubjedfc, in other re-
fpects, learnedly ?
For it is too hard to pronounce, that, out of fo many who have afTtrted this
to have been done, or feen, by them, there could not be any one that was
not decciv'd ?
And certainly if the obfervation of Slevogtius (>»), had been then publihYd,
or had come to his hands •, he would at lead, as well as Abraham Vater (;;),
have acknowledg'd this to have been free from all deceit.
For Slevogtius, upon cleanfing, from its fordes, a large body, that was cut
out from the pudendum of a woman ; which he fuppos'd to be an excrefcence ;
contrary to his expectation found it to contain the uterus, like a thick bag,
together with the remains of its tubes, and in a natural (late : and this was
feen by the profefTors at the univerfity of Jena, by moft other phyficians,
and by a hundred ftudents : yet this woman was very happily reftor'd.
But if you interrupt me by inquiring, why neither this woman, nor any
other, was immediately carried off; either by a confiderable hsmorrhao-e,
from fome of the larger veflels of the uterus being cut through, or, loon
after, by the large wound, which, when the bladder hangs downwards, toge-
ther with the uterus, mud neccflarily be inflicted thereon, as is remark'd by
Ruyfch fo); to the firft, I (hall, perhaps, anfvver, that the veffels being lono*
diftracted, and therefore contracted, and a corruption moreover gradually
helping the feparation, as is the cafe in the flefli, that is dead from a fphace-
lus, no great quantity of blood could be pour'dout: and to the fecond,
either that the vagina was inverted only in its upper part, or was not inver-
ted in the external coat, whereby it is join'd to the bladder; but only in its-
internal coat -, fo that it could not draw the bladder down with it.
But if you cannot approve of thefe replies, and fuppofe the circumftances
to have happen'd; for I am not univerfally pleas'd with them myfelf; you
will, of yourfelf, endeavour to find out better hypothefes : for we muft take
care that we do not feem to diftruft Slevogtius, or any other author of emi-
nence and credit, who afferts that he had examin'd the cafe, either in the
body that had been extirpated, or in the carcafe after death.
I could wifh Molinetti had made this examination (which he could have
done eafily and well) as he fays (p), that " he had always experiene'd" the
(&) Diflert. de Procid. Uteri, c. 4. hi) Difi". de Sarcom. e Pundend. Muliebr. St
(I) Progr. addit. Diff. Scliacheri de Placenta cact. thef. 7.
Morbus. (0) Thef. Anat. 8. n. 102.
(m) Vid. in cake obf. Van Sanden de Pro- \p% Differt. Anat Pathol. 1. 6. c. 12.
lapfu Uteri.
Vol. II. 4 K method
618 Book III. Of Difeafes of the Belly.
method of amputating the uterus, " to be very fafe; and that he had
" made ufe of it many times, efpecially in old women :" in whom, as the in-
verfion of the uterus, whereof he fays thefe things, is more rare, fo ouo-ht
the examination to be made with the more accuracy after amputation •, left
any error mould have crept in: the fufpicion of which, that perpetual felicity
of cure ieems to increafe.
There is even another much more recent obfervation •, of the uterus being
inverted, and fuccefsfully cut out; in which you would with that the exami-
nation, after ex faction, had not been omitted; as before this, the cafe is faid to
have been fimilartothat related from Wepfer, in the Ephemerides of the famous
Academy Nctura Curioforum Dec. 2. A. 5. Obf. 50 ; where you not only do not
find the uterus inverted, but even an excrefcence, which Wepfer himfelf had
(hown (q) might belong rather to the vagina, than to the uterus : and he even
afHrm'd it to have belong'd thereto, from what happen'd to the woman, in
the fpace of two years afterwards (r).
Nor indeed ought we to require an accurate examination of the uterus, when
inverted, only, but alfo when prolaps'd outwardly, with the vagina, in the
living and dead body ; efpecially after it is certain from the obfervation of
Widmannus, which has been quoted (j), that the prolapfus of the inverted
vagina alone, may fometimes fo impofe upon the obferver, as to make him
believe that the uterus was prolaps'd within it, at the fame time.
For if you compare the figures of Ruyfch (7), which exprefs this fecond
cafe, with the figure of Widmannus, which reprefents the firft, you will find
no difference ; to omit other things; in that which was confider'd as the chief
fign to diftinq-uiih one from the other.
That is to fay, as the os internum uteri, is in tne middle and lower part,
of the prolaps'd body, in the figures of Ruyfch ; fo you would alfo fup-
pofe that you perceive it in that of Widmann : whereas the diflection will
fhow, that it was only an appearance, made up of the vagina ; as by this the
internal coat of the vagina, being much thicken'd, was itfelf found to be pro-
laps'd ; but the uterus was found in its natural fituation.
By what means then, you will fay, fhall we diftinguifh the cafe in a livino-
woman ? A thing of the laft moment, certainly, where the queftion is of
amputating the tumour!
The fame enquiry has been made by Abraham Vaterfw), as by you. But
he has determin'd nothing : and has even declar'd, that any obvious fign is
ufelefs, depending upon that very diflection of Widmann.
To me however, from another certain circumftance, which, being obferv'd
before the diflection, by Widmann, made him begin to doubt whether that
which feem'd to be the uterus was really fo or not ; to me, I fay, a thought
arofe, of taking a fign from this very circumftance, whereby we may know
whether fuch a tumour be made up of the uterus or not.
For without doubt, if a long probe be introduc'd through the orifice,
which appears to be that of the uterus, and the fame thing happens to the
introducer, that happtn'd to Widmann ; I mean that the probe may be
(7) In Schol. ad n. 4. (0 Obf. Anat. Chir. fig. 2. 8. 1 1.
(r) Dec. ead. 2. a. 7. obf. 54. (") Dilfert. de Polypo ex Ucero egreflb thef.
(s\ Supra, n.2. 10.
pufh'd>
Letter XLV. Article 5. 619
pufh'd, without any obftacle, far beyond the natural length of the uterine cavi-
ty, and yet not come to the full extent of the prolaps'd body; and the tumour
is, at the fame time, not eroded by an internal putrefaction -, a proof, in my
opinion, will be given, that this orifice does not belong to the uterus, but
only to the vagina •, and fuch a proof as, to my apprehenfion, ought not, in
an ambiguous, and very difficult cafe, to be defpis'd : but if the contrary
happens, to the contrary conclulion may we fairly be biafs'd.
And if they who have contended that the uterus never defcends, nor is
prolaps'd, hadexamin'd the cafe very frequently in dead bodies by difTedtion •,
they would have thought, that we were not under a neceffity of refering all
the obfervations, of others, to the prolapfes of the vagina alone, or to the
excrefcences of that, and the os uterinum : as if, in fad, it were impoffible,
that what they themfelves had not feen fhould ever have been feen by any
Other perfon.
5. Indeed we very readily, and without any reluclance, grant thefe gen-
tlemen, that they who affert their having cut away the uterus, have been,
almoit all of them, deceiv'd by excrefcences of that kind •, or by prolapfes
of the vagina: and this alio muff, beconfefs'd, whether they are willing or not,
by thole who have told us that the women have brought forth children after
theexcifion ; unlefs they fhould perhaps contend, that two of the moft extra-
ordinary things imaginable, had happen'd in one and the fame woman ; firlt,
that fhe fhould furvive the excifion of the uterus •, and fecondly, that fhe
fhould have a double uterus from the original formation.
But, as I had begun to fay, does it follow from this ; that fo many furgeons
have been deceiv'd in taking excrefcences, and prolapfes of the vagina, for
the uterus ; does it follow, I fay, from hence, that all have been equally de-
ceiv'd, who have aflerted that they have feen a defcent of the uterus, or a pro-
lapfus thereof?
That this certainly does not follow, not only reafon itfelf evidently fhows;
but alio a great number of obfervations, which may be added to fome that
are produe'd in the Sepulchretum, demonltrate.
Slevogtius (x) will point out thefe obfervations, though I am filent ; and
Van Sanden (y) likewife ; who is very full in collecting thofe obfervations,
•which belong to this fection of the Sepulchretum •, that is the thirty-fecond :
in the additamenta of which fection, it is furprizing, in the firft place, that
thofe obfervations fhould be wanting, which might, at that time, have been
taken from the Centuria of Ruyfch ; and in the fecond place, that we do not
rneet even with the obfervation which we find in that well known book of
Bohn, and which I fhall take notice of prefently. *
To thefe you will add thofe that were not then extant ; part of which have
been already refer'd to, and part of which will be refer'd to below ; and
others befides thefe, either of the defcent of the uterus, or of the prolapfus
of it •, to which belong one of Vater's (z), and one of the celebrated Phila-
dolphus Boehmerus (a) : both of which, as well as the others, are very clearly
confirm'd by diffeclion.
(x) Diflert. de Mulierc gravida lapfu Vag. (x.) DiiTert. de Polypo & cast. ibid. cit.
Uteri, & cxt. §. 12. thef. 8. in fine.
(j) Qbf. fupra ad n. 4. cit. (a) Dillcrt. de Prolapf. & Inverf. Uteri, iit
Prxfar.
•4 K 2 6. How-
620 Book III. Of Difeafes of the Belly.
6. However, although " the fight of an inverted uterus, is too rare " to
ph\ ficians, and furgeons, as I have written in that epiftle upon Celfus {b) •,
and although de Graaf has faid (c)y that " this happens very rarely •," yet that
this is not very rare to midwives, and efpecially to the unfkilful, and happens
very often in the child-bearing women of fome countries, I underftand from
books ; and in particular from the fecond Decade [d) of Ruyfch's Adver-
faria.
For it appears plainly from thence, that the uterus is not always forc'd
<lown, and inverted, by the unfkilfulnefs of midwives •, nor from the violence
of pains, at the time of child-bearing •, but alfo from the attempts made
" to unload the uterus, after birth."
There is another caufe befides, but, in regard to this effect, far more rare ;
I mean when a very large excrefcence, that had form'd itfelf upon the fundus
uteri, inverts the uterus by its weight ; and draws it downwards, in the man-
ner that Sandenius has propos'd (e).
And it is certain that anatomy (hows the uterus to have been inverted ;
for within its cavity, form'd by that furface, which had been before exter-
nal, the ligaments of the uterus, the Falloppian tubes, and the ovaries, have
been found to be contain'd.
And in this way you will very eafily conceive how it could happen ; in the
obfervaricn transferr'd into the Sepulchretum (f), from Henricus ab Heer,
upon a uterus cut out by a mountebank ; that a confiderable part of the in-
tcftine colon was prolaps'd, and was amputated together with it; in confe-
quence of being contain'd within its cavity, when inverted.
You will alfo gather from an obfervation of Sandenius (£), that a woman
may fometimes live many weeks with the uterus inverted, and not replac'd ;
and even from the cure of Genfelius (&), that the woman has been fav'd by
refloring the uterus, at length, to its fituation, after having been difplac'd
for many days.
But thefe things are rare, if you compare them with fo many other cafes
that were fpeedily fatal •, to which we muft add that produc'd by Bohn (7), of
a woman, who had brought forth her firft child, dying within lefs than an
hour after the uterus had been violently drawn down from its feat, which
was found to be empty ; and that alfo related, from Chapman, by Boehme-
rus (k) already quoted ; in which, if I rightly underftand it, the woman died
ftill fooner from the like accident.
The other prolapfus of the uterus likewife, that is without inverfion, fe
neither fo frequent, that "Blafius, in his commentaries upon Veflingius, related
" a whole catalogue of the obfervers of it," as de Graaf has blunderingly
written (7) •, nor yet, on the other hand, fo rare, that " nobody befides
" Ruyfch" has ever feen it ; which would never have efcap'd Widmann (>»),,
[b) IV.
(<•) De Mulier. Organ, c. io,
(d) C. io.
(e) Obf. fupra ad n. 4. cit.
(f) Seft. hac obf. 6.
{£) S- *7-
(IS) Aft. Erudit. Lipf. A. 1716. M. Maj.
(?) De Renunc. Vulner. fed. 2. c. 4. verC
finem.
(k) Diflert. fupra ad n. 5. cit. §. 13.
(/) C. cit. 10.
(//;) Obf. fupra ad n. 2. cit.
if
Letter XLV. Article 7, 8, 9, 10, it. 621
if he had not forgotten, as frequently happens in fuch cafes, the obferva-
tions of Platerus v , \ nd Peyerus (0).
The defcent of the uterus rather, and the prolapfus of the vagina chiefly,
occurs pretty frequently. It has therefore happen'd, that I have never heard
of the prolapfus uteri, when inverted, more than once, in this country ;
and of the uterus, without inverfion, not lb much as once.
Bur the defcent of the uterus, and the prolapfus of the vagina, I have
fometimes feen, not only in the living body, but made obfervations upon, in
the dead.
7. Being afk'd to examine the genitals of a woman of reputation,
about five and twenty years of age, in order to determine the nature
of a certain body, of a round figure, like a penis, which hung down within
the vagina ; I immediately perceiv'd it to be the cervix uteri, which had
fallen down below the middle of the vagina.
The ofculum uteri, as, though the woman was married, (he had never
born children, was narrow, and almoft in the fhape of a circle : and from
thence I faw a little blood proceed •, for the woman had lately menftruated ;
fo that if any one fhould doubt whether the menftrual blood comes from the
uterus, or not, he might have been convine'd by this infpe&ion.
But now I will tell you what we have obferv'd in dead bodies •, firfl in
beads, and after that in women •, for by this means it will be clear and evi-
dent, that thefe diforders are brought on, not only by weight, but by other
eaufes alfo, which adr. on our bodies, according to the mechanifm thereof.
What I fhall firfl: relate I formerly receiv'd from Valfalva.
8. When he was dilTecting a bitch, which died pregnant, he found the va-
gina inverted ; and the adjoining uterus confidcrably nearer to the orifice of
the vagina than ufual. And this change in the fituation of the uterus was
alio confirm'd by the cornua, and efpecially the right •, in which were three
young whelps. For they had follow'd the uterus towards the vagina, and not
at any great diftance.
9. A cow, which had been fubject to a prolapfus of the vagina, the ma-
fter of her would have to be kill'd for this very reafon, when me was ad-
vane'd feven months in her pregnancy •, fearing left fhe fhould die in bring-
ing forth her young ; fo that her vifcera, and flefh, would be fold at a very
low price.
Having got the vagina, together with the uterus, I found the former in-
verted to ibme confiderable extent-, where it is connected with the extremity
of the cervix uteri. But in that part it was not without ulceration. What
I obferv'd in the uterus and the foetus, was agreeable to their nature ; for
which reafon it does not belong to this place.
10. But as, in thefe brute animals, the difeafe could not be imputed to the
weight forcing or drawing downwards ; fo in women I believe that it fre-
quently may be : as it might in her of whom I fhall fpeak immediately.
n. An old woman of Bologna had already been hemiple&ic many years,
fo as not to be able to move one fide of her body •, when at length fix*
loft the power of motion in the other alfo. The fame woman was faid tx>'
(«) L. 3. (0) In Additam. ad hanc Sepulchr. feet. obf. 5.
2 have.-
622 Book III. Of Difeafes of the Belly.
have a certain round body prominent from her genitals. Laft of all me was
ieiz'd with an inflammation of the thorax, and died in this hofpital ; where
we diifecled her body about the year 1704.
The thorax we did not meddle with j being taken up with other dif-
fections.
The head, which was open'd by fome of my friends, fhow'd nothing
worthy of notice ; except ferum betwixt the dura and pia mater.
I myfelf examin'd, with fome accuracy, the thyroid gland ■> as it was tu-
mid, and very hard •, and the belly likewife, as to what related to the ute-
rus, and the other genitals. What I found in that gland is fufficiently mown
clfewhere (p).
But in the belly, I obferv'd that the fundus uteri had a fomewhat lower
fituation than it generally has ; yet not fo much as to make me fufpect, that
the orifice thereof could come where it really did, as I mall tell you pre-
sently.
On the outfide of the labia of the pudendum, which was much dilated,
a body of the length of three or four inches was prominent : this body was
of a cylindrical form, very thick, made up of a fubftance, fimilar to a liga-
ment, and fmooth •, unlefs where it was ulcerated at the bottom.
That it was the vagina inverted I readily perceiv'd. Wherefore, at the
upper anterior part of this body, was'the orifice of the urethra •, and under
this, on each fide one, were foramina of lacunae confiderably dilated.
And in the middle of the lower part was an orifice, that foon led to the
ofculum uteri, through which I pafs'd a prob?, without any difficulty, quite
to the upper parietes of the cavity of the uterus.
Being furpriz'd at this unufual length, I cut into the vagina •, and within
it I found the cervix uteri contain'd, having become very much longer than
it naturally is : nor was this to be wonder'd at j fince the parietes of the cer-
vix itfelf, and the fundus uteri, were not firm, as they are in their natural
ftate, but extremely lax, and flaccid : as all the other parts, that had their
Jeat in the pelvis, and belong'd to the uterus, were likewife.
12. It is evident that the uterus, whofe fundus was fomewhat lower than
-ufual, had been drawn downwards by the weight of the vagina thus thicken'd;
unlefs the cervix, from the very beginning of the diforder, fuppofe, was of
fuch a laxity, as to fuffer itfelf to be drawn downwards more than the other
parts, arid be diftended into that extraordinary length : for I do not imagine
that length of it, which Vaterus (q) tells us was feen by him'; when, on one
hand, the prolaps'd vagina drew the uterus downwards, and on the other the
enormous fize of the ovarium prevented it from defcending any farther ;
to have been comparable with this.
But in another woman, whom I defcrib'd to you in the thirty-fourth let-
ter (r), the increas'd thicknefs, and, confequently, increas'd weight, of the
-corpus glandofum urethras, had indeed drawn the uterus fomewhat down-
wards : but becaufe the cervix was not of fuch a laxity, the orifice had not de-
icended fo far •, for which realbn this very corpus glandofum, being perforated,
(p) Epift. Anat. 9. n. 39. (r) N. u.
(q) Dill", de S;ucom. & est. fupra ad a. 4.
- . thef. 3.
in
Letter XLV. Article 13.
623
ia the middle of its lower parr, with the orifice of the urethra, refem'
the orifice of the uterus. Nor, indeed, could the weight of the uterus be
there accus'd •, as it was but fmall, ami the parts of it but thin.
Yet in faying this, I do not neceflarily deny, that a uterus, overloaded by
a weight which is preternatural, does, in other women, invert the vagina •,
and hurry it downwards together with it -, a very clear inllance of which you
have in the obfervation of Hartmann, that is related among the Additamcnta
to the twenty-firfl fcclion of the Scpulchretum (.f).
You fee then, that not only the weight of the vagina, by diftrafting the liga-
ments of tiie uterus, fometimes draws this downwards to the lower parts ;
but alio that the weight of the uterus, at other times, by diftending the
parts which connect the vagina, inverts this cavity, and draws it downwards
with itielf.
For both the ligaments of the uterus, and the connecting parts of the va-
gina, do luffer themfelves to be diftracted ; as they are membranous, and
frequently very lax from internal caules ; and this diftraction, whereof we
fpeak, is often known to be coming on gradually, and for a long time to-
gether.
That prolapfus uteri, which Peyerus (/) has defcrib'd, was certainly large-,,
as the uterus was pufh'd out at the pudendum, and hung within the inverted
vagina. " Neverthelefs," fays this excellent anatomift, " the ligaments of
" the uterus, and bladder, were not ruptur'd, but only relax'd."
And he faid, " the ligaments of the bladder, becaufe the urinary bladder
" had fallen down, together with the uterus, and chang'd its fituation •/' as
he found by diflection ; which circumftance, though it then feem'd to him
*' wonderful, and altogether new," Ruyfch (u) has fince admonifh'd will al-
ways necelfarily happen, in prolapfes of this kind.
13. And if thefe cafes feem to be very furprizing, which are, neverthe-
lefs, generally brought on by degrees, as I have faid, and in a long courfe of
time j that certainly deferves our admiration, which, though it is much lefs>
is brought about very fpcedily, and in a fhort time, by nature itfelf.
For in the birth ; to ufe the words of Slevogtius (x) ; " the ofculum uteri
*' comes very near to the orifice of the vagina, and diftends it, from a long
** pliable canal, into a large circle; correfponding to the fize of the embryo
'*• which is to pafs through it."
And, indeed, where, by reafon of the thicknefs of the foetus, and the nar-
rownefs of the pafiages, the birth is brought on but flowly, and with con •
fiderable difficulty ; " it then frequently happens, that, by the continued ex-
" ertions, of the woman,, to bring on the delivery, the opening of the ma-
" trix is evidently propell'd by the head of the infant, and carried to more
" than the length of an inch, or two, on the outfide of the vulva:" for this
appearance, which Munnickius had fuppos'd to be very rare ; Slevogtius tefti-
fies " had frequently occurd to himfelf -x and had not portended any mif-
" chief."
(s) L. 3. obf. 54.
(/) Seil. hac 32. Sepulchr. obf. 5.
(u) Loco fupra indicat. ad n, 4.
f>) Diifcrt. fupra ad n. 4.
But
624 Book l|I. Of Difeafes of the Belly.
But this is dill more fin-prizing-, that, though a gravid uterus hashung down
within the inverted vagina, beyond the lower parts of the pudendum, the
foetus has, neverthelefs, been brought forth.
And that obfervation of Harvey (y) himfelf, which is, as far as I know,
the firll of the kind, you will add to the others that are collected by San*
denius (2) : whereto that alio belongs, which was afterwards propos'd by that
excellent profefibr at Helmitad, Fabricius {a).
And although fuch a number of obfervations may ferve to convince thofe,
by whom the prolapfus uteri, within the inverted vagina, was denied •, in the
fame manner as that obfervation may, which the celebrated Friedius commu-
nicated to Widdmann (b) ; yet here I would have you attend only to thofe
•of them, that reprefent the uterus to be thus prolaps'd in the very birth.
For you will be lefs furpriz'd after this, that thofe diffractions of the li-
gaments I was fpeaking of (c), which come on gradually, and in a lono-
fpace of time, may happen; efpecially as women thus affected, are not with-
out a troublefome fenfation, that correfponds to thefe diffractions, and either
•do not difcharge the contents of the rectum, or bladder, or both of them,
with their ufual facility : which difficulty, in a certain woman whofe vagina
was prolaps'd outwardly, as it was reliev'd by raifing up this prolapfus;
S'evogtius (d) accounted for, not fo much from the compreffion of thofe
meatufles, as from the ~diftortion thereof, on account of the annex'd fibres
of the pendulous vagina, drawing them in an oblique direction ; and by this
means conftringing, and making narrow, their cavity.
However, he made the connexion of the vagina much larger than it really
is •, as he thought (e) " that the vagina was very clofely connected, in its
■" whole length, to the fubjacent inteftine."
14. It is true, I do not deny that the doubts, which have been already
advane'd by me (/), cannot be entirely remov'd from my breaft; except by
a. previous and very accurate examination, of the bodies, of thofe who la-
bour'd under thefe difeafes : an opportunity of which examination I have not
had for a long time.
Among thefe I, without doubt, confefs the prolapfus vaginas to be the
mod frequent ; and grant that it has impos'd upon many, for a prolapfus
of the uterus.
But does the internal membrane of the vagina, relax'd, and extended, by
an afflux of humours, fall down of itfelf only ? Or do both of them fall
down ?
That the former " happens very frequently," not only many authors,
among whom is Wedelius (g), affert; but even, according to the affertion of
Widmannus (£), " all agree."
And indeed, where you put the cafe in this point of view, you make fome
lj) In Addit. ad Exercit. de Ger.erat. ubi (c) N. 12.
de Partu. (d) Difi'ert. modo indicat. §. 16.
(2) Obf. fupra ad n. 4. cit. §. 6. & feq. (e) Ibid §. 1 1.
(a) Program, quo facii. Extraft Foet. in (f) Epift. 33. n. 15.
ProciJ. Uter. ( g) Diflert. fupra ad n. 4. cit. c. 1 & 2.
{6) Obi", i'upra ad n. 2. cit. (/•) Obf; fupra ad n. 2. cit.
Letter XLV. Article 15. 625
of tlve difficult circumftances eafy to be underftood ; one of which I have
hinted at above (i) ; and another is pointed out by Wedelius (k).
But in the mean while ; efpecially if the prolapfus is of a !',reat length,
and ftill more, if, as Widmannus (/) propofesitj the internal membrane, being
torn away, from the upper part to the lower, and reflected downwards, oc-
cafions the prolapfus ; you muft, of courfe, fall into fome of thcle doubts,
which 1 have laid are already pointed out by me.
Yet the inverlion of all the parietes of the vagina, at one time, is not very
eafy to be expiain'd.
Befides, fuppofe which you will of thefetwo circumftances, it is not fo clear
how thefe parts, by the afliftance of remedies, can, fometimes at leaft, reco-
ver their former fuuation, and remain therein; after ilich diftractions of the
ligaments, and connecting parts.
15. One remedy made ufe of by art; befides others, both externally and
internally applied ; is that of peflaries conftructed in the form of a ring, or
any other fliape, which has a foramen to it. And we muft not omit to make
ule of this kind of remedy here alfo ; as we frequently muft in the prolapfus
of the inteftinum rectum.
For there are two circumftances, in this cafe, which render the cure more
difficult than in the other ; firft, the inevitable weight of the uterus, when it
has fallen down before, again inverting the replac'd vagina ; and fecondly,
the fpincter muicle keeping the orifice, of the vagina, (hut up neither lb
ftrongly, nor lb clofely, as the fphincter ani does the orifice of the inteftine.
And for thefe reafons, then, the vagina is again pufh'd outwards, refem-
bling either an inteftine, or fome other body ; as, for inftance, from what we
havefeen in Hippocrates (»;), " the fcrotum ;" which it alfo refembled in the
oblervation of Harvey (n).
That a dilbrder which is indecent, or, certainly, inconvenient, may be re-
mov'd, or at leaft conceal'd, thefe peflaries have been invented. And if all
the inftruments of this kind ; of whatever form, or ftructure ; that have been
yet known, " were fo far from curing" a prolapfus uteri, " that they ge-
" nerally made it worfe ;" as I lately read in the works of a learned man ;
they would have been long ago rejected by phyficians, and furgeons, and
even by women themfelves.
I, however, obferv'd this inftrument to be rather ufeful, when I diflected
a woman who had been fubject to this difeafe ; as I have already written
to you (0).
Yet I do not deny that where they are introdue'd with violence, or impro-
perly, and fooliffily conftructed, they may either bring on death, as was
feen to happen by Benevoli (p), or fome detriment at leaft ; efpecially if the
women, neverthelefs, perfevere a very long time in the ufe of them : and
do not ever take them away, even for the fake of wiping and cleaning them.
(;') N. 4. («) Loco fupra ad n. i3.indicato.
(i) DifT. modo indicata c. 4. (0) Epift. 22. n. 22. in fine.
(/) Obf. indicata. (p) Offervaz. 3.
(//;) Supra n. 3.
Vol. II. 4 L You
626 Book III. Of Difeafes of the Belly.
You may fee, in the Commercium Litterarium (q), what happen'd to two
women for the fame kind of reafons.
You will find that one of them -, having introduc'd a ball of thread, or
worfted, wound up together, had a tartareous matter, as it were, concreted
upon it, to fuch a height, as every where to equal three fourth-parts of an
inch •, and of fuch a hardnefs, that it could not be chipp'd off without an in-
ftrument for that purpofe •, and, finally, that it gave fuch uneafinefs as already
to have brought on a very fevere ftrangury : and that the other had an
ulcer of the vagina, and the neighbouring inteftine, in confequence of an
iron peffary ; notwithftanding it was cover'd over with wax, as that ball of
worfted had alfo been.
To thele I will add an obfervation of my own, which although I mould
more willingly have related, among other diforders whereto it more peculi-
arly belongs ; if I had made it before I treated of them ; yet I did not think
proper that it fhould be omitted in this place, as it relates to the prefentfub-
ject, in the latter part of it at leaft.
1 6. A woman, of a middle age, and Mature, and of a pretty good habit
of body, labour'd under no other diforder, but a catarrh, from the injuries
of the cold air, when a fever was added to it ; on account of which fhe was
immediately brought into the hofpital.
For this fever was acute, andjoin'd with a great difficulty of breathing, a
rednefs of the cheeks, and a very troublefome fenfe of weight in the thorax ;
together with a fomewhat hard pulfe.
Every thing that was neceffary was done •, but without any effect. To ex-
pectorate was the only thing fhe defir'd ; yet fhe never could.
At length her pulfe became very low, and intermittent ; and her refpira-
tion fo difficult, that fhe could not lie down in the latter part of her diieafe.
Wherefore fhe died, on the fifth day from the time fhe began to be feverifh-,
which was about the middle of March in the year 1748.
The carcafe was diflected in the hofpital (for the fake of the ftudents) ac-
curately and in order. But I will here firft declare to you, what I found pre-
ternatural in the thorax and head.
Although the lungs were turgid, and almoft every where clofely connected
to the pleura, that lin'd the ribs •, and efpecially on the left fide ; yet from
the left cavity of the thorax, a ferum ; which you would very readily have
iuppos'd to be white from a mixture of pus, if there had been the leaft token
of pus in that part ; fiow'd out in fuch a quantity, as the (late of the left fide
of the diaphragm, which was not vaulted, but rather deprefs'd (when we
look'd upon it from the cavity of the belly) had before argued.
Part of that kind of ferum was particularly confin'd betwixt the left lobe,,
jnd the pleura, where it inverted the ribs, pretty near to the middle vertebras
of the thorax-, and that for a confiderable tract; in which tract, both the
lungs, and the pleura, had white concretions adhering to them, like very
thick membranes : and in that part only the lobe was found to be grown
ewh a hard, and denfer than ufual.
"Yet the patient had not complain'd of any peculiar uneafinefs in her back ;
(qj A. 1733.. hebd, io» n. 5. & a. 173$. hebd. 32. n. 1. ad part 7.
noz
Letter XLV. Article 16. 627
nor yet of any pungent pain ; although the pleura was, in both fides, of a
rofy rednels for a confiderable (pace : nor, finally, had flic at any time com-
plain'd ; for I inquir'd particularly into all theft circumtlances •, of a tremor
of the heart, or lwoonings, either in the holpital, or at home-, notwithftand-
ing I found thole appearances in the pericardium, that I am about to de-
le rib .-.
The pericardium was large, and full of a ferum, of that kind which was
found in the left cavity of the thorax •, fo that, at fail fight, you would
have tmagin'd it was fotne large ablcels, and not the pericardium, which
was open'd.
This ferum being exhaufted, all the interior furface of the pericardium,
and the external of the heart, auricles, and large veflels, appear'd of a pale
colour : being all cover'd over with a kind of matter which was of a white
colour, inclining to cineritious, and refembling nothing more than lime,
juft laid upon a wall in the form of a plailter ; fo that it immediately brought
to my mind Guarinoni, who, as I have already told you (>), found in this
kind of inflammatory diforders of the lungs, and pleura, the heart " co-
" ver'd over, as it were, with lime •," that is with polypous concretions (as I
there explain'd it, and here again law it) refembling a thick, but lax mem-
brane, which was very eafily taken off, and very ealily torn afunder.
And when thefe fordes were remov'd, all the parts that they had cover'd
came into view, and were of their natural colour, and conftitution •, except
that the pericardium was thicken'd, and reddifh : that is, not afte&ed with
an inflammation indeed, but with a kind of phlogofis neverthelefs.
The heart i'eem'd to be larger than natural ; and contain'd black blood,
on both fides, fuch as was met with in feveral parts of this body : and in
the right ventricle, and its annex'd auricle, were round polypous concre-
tions, likewife, contain'ol.
The medullary fubftance of the cerebrum, wherever you cut into it, and
the furface of the lateral ventricles alfo, fliow'd fmall veflels turgid with
blood : and in the fame ventricles was a ferum of a colour inclining to a dirty
yellow.
In the belly I had obferv'd thefe things. The fpleen was large ; the liver
very large •, lb that filling up the left hypochondrium alfo, as well as the
right, it prefs'd down the ftomach : a portion, therefore, of the gula, termi-
nating in the ftomach, appear'd at two fingers breadths below the dia-
phragm. But befides this magnitude no difeafe was perceiv'd in thefe
vifcera.
In the trunk of the inferior vena cava, was an oblong and thick polypous
concretion.
At length, in regard to the genitals, the uterus was fomewhat nearer to
the left fide, than to the right ; and fell forwards. The ovaries were very
long, but very flender, white and hard ; and were join'd to the uterus by
ligaments that were confiderably more thick than ufual. The veflels which
run through the broad ligaments of the uterus, were very turgid with black
blood ; and here and there varico.us.
(>•) Epift. 20. n. 37.
4 L 2 When
628 Book III. Of Difeafes of the Belly.
When I had carried on the dilTection from the upper part of the uterus,
to the lower orifice of the vagina, I Saw the cavity of the uterine fundus,
and the continued cervix, full of mucus •, which was almod transparent like a
jelly, ting'd with no colour, and thinner than that which is wont to be at
the orifice of the uterus, and was not wanting here.
When the upper mucus was taken away, a very fmall excrefcence, almofl
of the circumference of a circle, and of a red colour inclining to brown,
was fecn to be (lightly prominent from the internal Surface of the fundus.
And when the inferior and thicker mucus was taken away, the lowed part
of the cervix appear'd to be unequal with a kind of unufual, fhort, and
red lines, lying in a longitudinal direction, and being fomewhat prominent.
The vagina-, although it was not without rugas, from the middle of it
downwards •, was, in proportion to the ftature of the woman, who I have
laid had been of a middle fize, longer and wider than is natural •, and con-
tain'd, in its cavity, a wooden ring (the proof of a prolapfus) fituated in fiich
a manner as I never remember to have feen it before.
For as it was of an elyptical form, it had its longer axis plac'd according
to the longitudinal direction of the vagina •, and the fhorter axis, which how-
ever was fo long as to didend both fides of the vagina confiderably, plac'd
according to the breadth of that cavity.
Both of thofe fides therefore, in that part where they were prefs'd by the
ring, fhot forth into an excrefcence, of the fhape and fize of a large decor-
ticated almond ; of a cartilaginous hardnefs, and white, except that one
of them was livid in the middle •, fo that an approaching change, from a
Scirrhous nature, into that of a cancer, feem'd to have been at hand.
17. Thus far then of the uterus " when prolaps'd outwardly; now, as I
have promis'd you (j), of the uterus " when retracted inwardly."
But I do not fuppofe that you expect, in this great light of anatomy, that
I fhould relapfe into the old exploded, and long rejected error ; and believe,
in concert with old women, that the uterus Sometimes afcends to the Septum
tranfverfum, and even, by permiffion of the almighty God, to the fauces
themfelves. Whether fome of the ancients, following Galen (/) •, who was a
dranger to this kind of errors ; following him, I fay, more in words than in
reality, have afcrib'd a power of afcenfion to the uterus; or others deceiv'd,
like Fernelius («), by flatus didending fome lax part of the convuls'd inte£
tine, into the form of a globe, have affirm'd that they have, with their own
hands, actually found the uterus to be carried up into the domach ; we how-
ever underdand by the words of Hippocrates, which we dill retain, utcro-
rum introcedentium, " of the uterus being retracted inwards," not the uterus
afcending upwards, but only an irritation from the uterus ; under which
name I here comprehend the tubes alfo, and the ovaries ; afcending by
means of nerves, and membranes, to the Superior parts.
And although by the term oihyjlerical cffeRion^ we believe that this diforder
only, which I havejud now mention'd, can with propriety be intended ; yet I
am not fo obdinately refractory to the common cudom, as to be willing to dil-
pute with thoSe, who compriie under this Same appellation, the various, and
(j) N. 1. (u) Patholog. 1. 6. c. 6.
(/) De loc. aff. 1. 6. c. 5.
multi-
Letter XLV. Article 18. 629
multiform diforders of women, which often wife from other cauics: as I I
wife (hall not difpute with thole perfons, who choole rather to call th(
hypochondriacal-, although, very frequently, the hypochondria are no more
in fault in patients of either lex, that they call hypochondriacal, than the
rus is in thefe women whom others call hyfterical.
If there be any thing common to both, the chief diforder is in the ner-
vous fyftem as it is cali'd : and I think the celebrated Flemyng(x) has a
with great propriety, in "comprising the diforders of one, and of the otl
(pedes, under one general title of Neuropatbia.
We are not furpriz'd therefore, when attacks of this kind arife fuddenly •,
not from the uterus, nor from the hypochondria ; but from terror, or in
nation: or even from fome peculiar odour. Thus I ike wife we understand,
how we have frequently, and happily prevented, or overcome, thefc attacks,
by the opportune giving of opium.
For, although the origin of thefe attacks, or paroxyfms, might feem to be
from the lower belly ; and even from the hypochondria' themfelves, and the
uterus ; yet the propagation of the noxious motion was, without doubt, made
by the nerves and the membranes.
You have already had an example, from me, of a recurrent epilepfy be-
ing prevented in its paroxyfms, by the ufe of opium (j). I will now tell
you, in a brief manner, how I prevented, by means of the fame remedy,
thefe hyfterical paroxyfms, as they are cali'd, in two women.
18. There was a matron of a genteel family, who was afflicted with want,
and the abfence of her hufband ; to whom fhe had born many children in her
more flourifhing time of life.
This woman was feiz'd with an intermitting fever-, the beginning of which
became more and more troublefome every day, by reafon of the cold increaf-
ing. And behold, during this cold fit, fhe was feiz'd with fo great a diffi-
culty of breathing, that fhe could not perform this function, without her
neck being eredr. ; nor without a ftertor, and fuch a conftriction of the cheft,
that, tofilng and writhing herfelf about, in the utmoft anguifh, fhe cried out
Ihe was juft going to die.
The patient herfelf, and thofe who were about her, then believ'd, that
the cold fhe felt, as well as the other fymptoms, were to be charg'd to the
account of the beginning fever.
But as the fame fymptoms, and indeed more violent ones, often recurr'd
at other times, and were even attended with very frequent, and fpeedy con-
cuflions of the whole body ; and moreover with fuch a conftridtion at the
throat, that, though fhe felt excruciating anguifh, ihe could not cry out -, it
appear'd clearly to every one of what nature the complaint was.
It coft me a great deal of time, and a great deal of difficulty, to cure thefe
hyfterical paroxyfms, firft ; and after that the febrile paroxyfms.
About a year after this, as I remember, when other intermitting fevers,
and, after fome days, thofe very violent attacks began to return again-, but
at the fame hour every day, I refolv'd to prevent them from returning if
poffible. Wherefore, one hour, or fomewhat lefs, before the fit was to come
on, I gave her half a grain of purified opium.
(*) In Neuropathia, (y) Epift. 9. n. 7.
She
630 Book III. Of Difeafes of the Belly.
She had no attack on that Jay, none on the two fallowings days, on which
the fame remedy was repeated. On the fourth day however ; to be faithful
and conceal nothing ; the difeafe was more powerful than the remedy : per-
haps becaufe nature was accuftom'd to it. But as this attack was much fhorter
than the former, and did not return any more ; nor the ftrength of the pa-
tient was fo much diminifh'd as it had been ; I got rid of the fever much
fooner, and more eafily, than in the preceding year.
19. What led me to fay that perhaps nature was accuftom'd to this remedy,
another example will fhow. A virgin, of a flender habit, labouring under
an obftinate hardnefs of the liver, and fuch a number of different, and long-
continued, fymptoms of difeafe, that nobody could have believ'd fhe would
live to be of woman's eftate ; and much lefs that fhe would arrive to a de-
crepid old age ; for fome little time ago fhe was ftill living ; was vifited al-
moil every day by me, nearly about the fame time that I attended the matron
I have been fpeaking of: which was when I was a very young man, and
practis'd phyfic in the place of my nativity.
For to the other diforders, among which I remember that there were much
more fevere pains of the head, and a greater irregularity in the uterine dif-
charges, than in the matron, a fever was added ; which return'd every day at
evening, with a coldnefs. With this coldnefs, a fenfe of compreffion, and
flreightnefs, at the cheft, and a difficulty of refpiration, began to attack the
patient.
And this was fo much increas'd within a very few days, as to oblige the
patient to fit down, diftort herfelf, and throw her arms about, and complain
in a miferable manner, when fhe could ; for fometimes it was not in her
power to complain.
All remedies were in vain ; firft to prevent the increafe of the attack, and
Jecondly, to prevent its return ; till I had recourfe to purified opium, by
means of which I every day prevented the paroxyfm : and, after fome days,
found that it did not recur, although the opium was omitted.
On the four-and-twentieth day after this, when the attack had return'd
again, and I had endeavour'd to overcome it by the fame method, but not
with the Tame fuccefs ; it came into my mind not to change the remedy, but
the form of it.
For this reafon therefore, having given ; at the fame diftance of time from
that in which the fit was expected •, as many drops of Sydenham's liquid lau-
danum, as aniwer'd to the half-grain of the former folid laudanum, I fo far
obtain'd my wifhes, that I had no more to combat with this paroxyfm arter-
-wards as before -, but only with the other diforders.
But it was lefs furprizing that, in this virgin, opium fhould have put to
flight paroxyfms which were evidently convulfive, than that, in another hy-
fterical virgin, fpoken of by Riverius (2), it fhould have overcome the fame
paroxyfms, join'd with a very oppreffive foporific diforder ; and even then
in another where the paroxyfm made its attacks not only with a foporific
diforder, but alio with a fhort continued paralyfis of the limbs. For thefe
tliforders were remov'd by my friend Guliermi, an ingenious phyfrcian, at
{zj Cent. 2. obf. 26.
Feltri,
Letter XLV. Article 20. 631
Fckri, in the fame manner as the others were by Riverius when remedies of
a different nature had been of no effect.
However, in the patient of Riverius convulfive fymptoms were not want-
ing i and in the laft there was a periodical coldnefs of the whole body. Which
one very lymptom, that experienced man Berryat (a) did not hefittte to confi-
der as a convulfive fymptom, in thole intermittent fevers •, and to look upon it
as the caufe of thefe different fymptoms, that follow'd in different cafes: lb
that if he could prevent that, he would alio prevent thefe : and this he afferted
lie had obtain'd, by giving a medicine with opium in it, one hour before the
beginning of the cold fit.
And you will perceive, that the four cures of women I have fpoken of,
which were brought about in the fame manner, even before he wrote, agree
with his opinion ; if you attend to this, that the violent fymptoms, in each
of them, generally recur'd at a certain hour of the day ; either with the cold
that preceded the fever, or continued to return every day inftead of the fever,
as in the laft.
20. What has fuccecded, with me, in preventing hyfberical affections, t
have already mown you. But, on the other hand, by what thefe paroxyfms
have been fometimes brought on, according to the observation of Hippolyto
Francefco Albertini, and John Jerom Zanichelli, as I have heard it from them,
I will not conceal from you.
The firft related, that, from the infufion of Sena, he had feen hyfterical
convulfions arife, more than once : and this you will readily believe might
happen, from the vellication of the inteftines, and the tormina that were ex-
cited in confequence thereof.
The other affirm'd, that he had certainly known Balfam de Copaibe excite
violent uterine diforders; which, unlefs you refer this effect to the fmell, that
is not very acute, nor very fweet, it will be lefs eafy for you to conceive of.
Here perhaps you will interrupt me, by inquiring whether this has likewifc
been obferv'd in hypochondriacal men ? And if not, why then do mod per-
fons at this time contend that the hyfteric and hypochondriac diforders are one
and the fame difeafe ?
But foftly, I beg of you. For the fame things are not always found to be
ufeful or injurious even in hyfterical patients : nor do the fame fymptoms
occur in all ; any more than they do in hypocondriacal men.
For which reafon it fhould have been lefs infifted upon ; by fome in other
refpects very learned men, who contend for the oppofite opinion ; that there
are fo many differences betwixt the two difeafes ; as if all thefe circumftances,
that they take notice of, were always obierv'd in hyfterical women, and moft
of them never in hypochondriacal men •, or as if thofe things which happen
much more frequently, and violently, in women, than in men, either were
not of the fame kind, and different only in degree ; or, to thofe who com-
pare the nervous fyftem of women, their bodies, and method of living, wit!:
thofe of men, it did not plainly appear, why the fame caufes fhould act much
moreeafily, frequently, and fharply, upon the nerves of the former, than on
thofe of the latter.
(a) Mem. prefente's a l'Acad. R. des Sc. torn. z,
2
632 Book III. Of Difeafes of the Belly.
Nor have I hinted at thefe things, becaufe I have a mind to enter into an
altercation with any perfon ; but rather to prevent others from entering into
clifputes -among themfelves.
And indeed if" you read over again what I have written above (b) \ you will
clearly fee what fide in this controverfy I fland upon : and although I very
well know, that, in all women who are call'd hyflerical, the uterus, its tubes,
or telles, do not betray any diforder to the inquiring anatomifl •, yet you will
fee that thofe women, in whom the irritations begin from thefe parts, are by
us properly call'd hyflerical.
Wherefore, if you fhould fay that there was fomething hyflerical, in that
widow whom I defcrib'd in the thirty-fifth letter [c\ who had been without
her menfes for eight months already, was not without a fenfe of fomething
afcending to the throat, and had a purulent puflule in the upper paries of
the uterus, and a matter, within the tubes, of a flefhy colour inclining to
yellow ; in this cafe, though perhaps I might, I fhall not contefl it with
you.
And I will even add to this, two hiflories of women, who, as they them-
felves and others fuppos'd it, I will alfo, agree were hyflerical •, if you will
firfl give me leave to take notice of as many, that you may add to the Sepul-
ch return.
One is that of the celebrated Mayerus (d), of a woman whofe uterus be-
ing large ; and which is a very extraordinary inflance, univerfally chang'd
into bone, fo that it was neceiTary to break it afunder with a hammer, in order
to examine its internal fubftance ; contain'd within its cavity, which was very
clofely fhut up at the os internum, a milk-like pus : but ibmewhat thicker
than milk, not foetid, yet, in its center, inclining to a green colour.
This woman, from the time that fhe began to obferve the tumour of her
uterus, was free from the hyflerical pafTion ; fo that you may fufpect this
paffion to have ceas'd, becaufe the uterus could no more be irritated.
The other hiflory is from the celebrated Helwich (*), who found four hol-
low excrefcences annex'd to the uterus of a woman externally, as if by a fmall
ftalk or flem, of the fame texture with the uterus itfelf; and a facculus pro-
minent from one of the ovaries : which facculus, when cut into, difcharg'd
a gelatinous and blackifh matter, to the quantity of half an ounce, with im-
petus.
This woman, as the fame author had declar'd in another place f/), was
evidently one of thofe, who, " it is agreed among all " jcians," are fub-
jecl: to affections of the uterus ; whether, to ufe the words of Galen (g) " any
" one choofes to call them apnoeas or fuffocations, or even a kind of con-
" tracYions fhall happen."
For, being feparated from her hufband, fhe had fallen into fuch a prurigo
of the genital parts, as to be but at little diflance from a furor uterinus : fo
as to render it not at all furprizing, that horrible fpafms fhould be brought
on ; by which the fauces were fhut up, and fuch a difficulty of breathing occa-
(b) N. 17. (e) Eph. n. c. cent. 3. & 4 obf. 142.
{cj N. 16. (f) Earund. cent. i.& 2. obf. 148.
(d) Commerc. Litter, a. 1731. fpec. 30. poll. (g) Deloc. arF. 1. 6. c. 5.
n. 4. m
2 fion'd,
Letter XLV. Article 2 r, 22. 633
fion'd, that there was frequently great danger of a fuffocation •, by which
flic was, at length, fuddenly carried off; but that the polypi found in the
heart of this woman, were rather the effects than the cauiea o( this fuffocation,
you will naturally believe, if you afient to what I have written to you on tl
fubjecl, on a former occafion {b). But now let us go on to the two obferva-
tions that I promis'd you juft now.
21. A young woman who was a publie flrumpet, of a fat habit of body,
and much given to drinking, having formerly born children •, began, ai
liavingbeen without her menftrual evacuations for lour months, to be fubjecl
to hyfterical affedions : and after that labour'd even under a mania, and at
length died of univerfal convulfions in this hofpital, where I diffedrx-d her
body, about the end of February, in the year 1717.
The belly contain'd a liver of fuch a colour as a liver is when boil'd : yet
the bile, which had exfuded from the gall-bladder, had ting'd the inteftines
that lay near it with a very lively faffron-colour.
The tefles were white, hard, fcirrhous, enlarg'd beyond the natural fize,
and drawn behind the uterus, by their own weight as it were. The internal
furface of the uterine fundus feem'd to be fmear'd over with a kind of bloody
mucus, juft as if the menftrua were about to flow, or had very lately flow'd :
befides, on that very furface, a few fmalliih tubercles, like warts, were pro-
minent.
The urethra, which was perforated with frequent orifices of its canaliculi,
being open'd, gave out from fome of thefe orifices, upon gentle preffure, a
white and vifcid matter ; which, if every thing had not been found in this
part, might have feem'd to be pus, and given us a fufpicion of a virulent go-
norrhoea.
The thorax I did not open, as I was taken up with many obfervations,
which it is not neceffary to mention here.
The cranium had been faw'd open ; but the brain was differed by fome
perfons who did not think I intended to do it myfelf ; and that when I was
abfent: which very much difappointed me, as, upon the fcore of the mania,
and the convulfions, I mould have inquir'd diligently into the Hate of this
part.
It was, however, related to me, that nothing worthy of remark appear'd,
befides polypous concretions in the fanguiferous vefiels j which I myfelf alfo
faw, in thole that happen'd to remain.
22, That the liver has been obferv'd to be like one that is boil'd in drop-
fical perfons, you have in this third book of the Sepulchretum, fection the
nineteenth (i) ; and, in like manner, in the additamenta to the twenty-third
fection (&) : but in cacheclical patients only in the twentieth (/).
To thefe add thofe in whom a cachexy would very foon have appear'd ; to
which clafs I think may be refer'd the ftonecutter, and the porter : the for-
mer of whom I have taken notice of formerly from Jacobus Sylvius, and
the latter, as being diffected by me, in the thirty-fixth letter (m), and in the
{!,) Epift. 24. (1) Obf. 2. §. u
(i) Obf. 3. §. 12. obf. 4. §. 21. (») N. 27.
(k) Obf. 86.
Vol. II. 4 M third
634- Book III. Of Difeafes of the Belly.
third (n). And what this ftrumpet was threaten'd with, was clearly per-
ceiv'd by the fupprcfiion of her menfes.
But not to digrefs far from my purpofe •, to this related thofe verrucas as it
were of the uterus, and that (late of the teftes, which fhow'd dilbrders of
thefe parts to have preceded, as you may of yourfclf conjecture. In the next
woman, however, the difeafes of the fame parts were more manifeft.
23. There was a woman, at Venice, of forty years of age, of the lower
fort, of ill fame ; given to wine, of a proper ftature, healthy, and of a fat
habit of body.
1'his woman was fubject to fear, even from a flight caufe, from which fhe
trembled, and almoll fwoon'd away. She vomited often, fo as to retain no-
thing of foJid food •, and could not tafte of fifh by any means. When we
inquir'd, of her acquaintance, in regard to the reft of her diforders in parti-
cular, they conftantly anfwer'd that fhe had never complain'd of her head,
nor heart ; as for inltance, of any violent puliation, palpitation, or any other
diforder thereof ; nor had ever, that they knew of, been attack'd with in-
flammations of the thorax : and why I remark thefe diforders not to have
preceded, you will eafily understand, by reading over the account of the dif-
lection.
The only difeafe of which fhe complain'd, they faid was affections of the
uterus, which fhe afferted to be mov'd, here and there, through her belly, at
that time, and fometimes to afcend to her fauces, with a fenfe of fuffocation ;
from which fenfe however, fhe was foon freed.
On the very firft day of January in the year 1709, fhe complain'd about
evening that her ribs had fallen in as it were -, and order'd an old woman to
be fent for, who as the opinion of the common people was, knew how to
raife them up again.
Early one morning, when fhe faid that fhe was feiz'd with a very violent
hytterical affection, and that the uterus, moving about here and there, had
already attended to her fauces, fo that fhe was fuffocated thereby •, fhe died
within an hour, or at moft within two : having no foam at her mouth, nor
being agitated with any convulfive motions, that any of the by-ftanders could
perceive.
As it was the bufinefs of Santorini to diffect the body,and he, for certain rea-
fons, tho' he would have chofen it, could not defer it •, he beg'd of me alone ;
who always avoided difTecting bodies of this kind, till they had lain for a
proper length of time ; and even prefs'd me over and over again, by the
friendfhip I had for him, that I would be prefent at the difTection with him ;
and beg'd of me with this intent, that we might give the more time to the
inquiry, whether the woman was really dead, than to determine the feat of
the diforder from whence fhe died.
The former of thefe inquiries we made with the greater diligence, as we
found the eyes not very turbid, and the body fcarcely at all rigid ; and, at
the tenth hour after death, the thorax even ftill warm at that time of year.
Wherefore, bearing in mind thofe things that Galen (0) had taken notice of
from Heraclides Ponticus, and other ancient phyficians ; we omitted nothing
(n) N. 4. & 5. (0) C. 5. fupra adn. 20. cit.
X which
Letter XLV. Article 23. 635
which us'd to be done at that time, or fince, in inquiries of this kind: that
is to fay, a little lock of comb'd wool, the flame of a thin wax candle, and a
polifh'd glals applied to the mouth and noilnls : to place a cup full of water
on the fcrobiculus cordis as it is call'd, and to more than one part of the
thorax, as if we had divin'd the admonitions of Window (p) : to apply the
fingers, and the hand, not only to the region of the heart, but alio to the
carotid arteries in the neck, and to the iliacs where they defcend on the
anterior part of the oila pubis to the thighs •, the former of which was after-
wards confirm'd by the illullrious Senac {q), and the latter had been formerly
hinted at by Riolanus (;•) ; and to apply them repeatedly and attentively, if it
were pofTible to perceive any pulfe : at length, by blowing powders high up
into the noftrils, luch I mean as had a tendency to excite fneezing, upon
which Hollerius (s) greatly depended in inquiries of this kind.
Not content with all thefe experiments, and others of the like kind, hav-
ing perceiv'd, upon making a flight incifion into the fkin of one thigh, a
little blood to come forth, tho' (lowly, and continue to flow, we open'd the
vein of the cubit with a lancet, in the fame manner, as if blood were to
be taken away.
And then ineeed, a very little blood was difcharg'd: but ferum feparated
from the red part was difcharg'd alfo ; fo that we perceiv'd by this, that a
diflblution of the parts of the blood was made in that vein at lean:.
At this time, however, we were willing to make ufe of other experiments
likewife j which, if the woman fhould have happen'd to be opprefs'd with
any kind of pernicious fleep, might a£t by way of a very powerful ftimulus,
to awake her.
For we gradually fix'd the point of a very fharp inftrument under the nails,
after the manner of Fortunatus Fidelis (t) : but, in particular, we applied a
hot iron to the foles of the feet ; as Miftichelli (u) us'd to do, in order to
roufe apoplectic patients.
But all thefe things being in vain, and that heat which we had perceiv'd
about the thorax in the beginning having vanifh'd •, we determin'd to put an
end to our inquiries, as being quite fufiicient : neverthelefs we cut into the fkin,
firft, leifurely and by degrees •, always waiting fomeconfiderahle fpace of time,
betwixt one and another fhort and fimple incifion ; after that the adipofe
membrane, which was very thick, and finally the muicles themfelves.
While we were making all thefe different trials that I have related, we had
leifure to obferve that the limbs were not lean, nor yet the head -, but that
they by no means correfponded to the very fat abdomen and thorax : weob-
ferv'd befides, that the pofterior furface of the body, on which fhe had lain
at the time of her death, was of a red colour inclining to livid ; but that the
anterior part, neither in the head, nor at the neck, nor in any other place, if
you except the upper parts of the thigh, had any rednefs or livor.
Now I will relate to you what we found in the belly firft:, and after that in
(/) Mem. de l'Acad. R des Sc. a. 1738. (a) Apud Lancif. de Suhit Mort. 1. 2. c. <;.
(^) Traite du Coeur 1. 3. ch. 7. n. 5. n. 12. quodpofceaMiltichellius ipfe con fir ma vat
{r) Encheirid. 1. 5. c. 46. verf. finem. Tratt. .dell' Apoplefl". 1. 1. f. 1. c. 6. & f. 3.
(s) De morb. intern. 1. 1. c. 59. c. 3. caf. 8. & foj.
(/) De Relut. Medic. 1. 4. c. 1 .
4 M 2 the
636 Book III. Of Difcafes of the Belly.
the thorax ; for the head (and perhaps this was not necefiary) we had it not in
our power to difiect : but I will communicate the appearances, to you, in
fuch order, as to begin with the thorax.
When we had remov'd the integuments of this parr, and the mufcles, from
the bones, and cartilages, that lay beneath, a great diforder appear'd in
the latter ; which the very large breads, and the fat, that lay upon them, fo
far hid before dilledion, that no mark of it appear'd.
That is to fay, the fternum being outwardly prominent, at about half-way
of its length, rais'd up the adjoining ribs, with it, on both fides: but the
ribs which lay next under theie, fubfided very much : and finally, the laft
of the ribs •, I mean of thofe that are join'd with the fternum either by their
own cartilages or the intervention of others ; were again prominent, as the
natural ftructure of the cheft requires: wherefore, at each fide of the fternum
were large depreflions of the ribs, which the breafts, and the fat, made to ap-
pear equal and fmooth on the outfide ; as I have already faid.
Upon opening the thorax, the left lobe of the lungs was found to adhere
to the pleura in one part, though very (lightly : and the right lobe was found
to adhere very clofcly thereto, in almoft every part, by a kind of membrane
which was form'd preternaturally, upon the external coat of the lungs.
Both the lobes, when we cut into them, we found to be hard, and ten-
dinous, as it were, in many places ; and abounding with a frothy humour
befides, as if with a kind of laliva.
The pericardium contain'd a considerable quantity of water, of a brown
colour, and inclining to be turbid. And both fides of the heart contain'd a
black fluid blood, fuch as was found almoft every where in this body : the
right ventricle, moreover, contain'd a fmall polypous concretion, of a white
colour, but foft ; a fimilar one to- which was found in the pulmonary artery,
with a great quantity of blood.
With this fluid the right auricle was very turgid ; but the left was con-
traded. However, the ventricle annex'd to this auricle, being larger than
its natural fize, offer'd to us more than one circumftance worthy of obfer-
vation.
For, to omit that the tendinous fibrillar, which pafs betwixt the valvular
mitrales, and the columnar, feem'd to be in greater number than ufual ;
thefe columns were certainly thicker than they naturally are, and more hard :
fo that they feem'd to be much more of a tendinous than of a fiefhy nature ;
whether you confider'd the colour, which was white, or attended to the re-
fiftance they gave to the knife, in incifion.
Befides, in the parietes of the fame ventricle, fome places occur'd, here
and there, in which the flefliy fubftance of the heart was either white, or of a
red colour inclining to whitenefs ; fo as at firft to impole upon us under the
appearance, as it were, of glands : but it fhow'd itfelf to be fimilar to the
columnar, by that fame peculiar refiftance when cut into.
This difeale, of the flefhy fibres of the heart degenerating into a tendinous
nature, became the more evident, the more it went from the internal fur-
face of the ventricle, to the external furface, and it alio reach'd, externally,
to that place with which the feptum cordis correlponds.
And indeed the fat itfelf which lay upon this vifcus, was not quite in a na-
3 tural
Letter XLV. Article 23. 637
tural flate. For on the poikrior furfacoof the heart, itwasuncqu.il, for two
fmall tracts, in .1 longitudinal direction ; and in the lame place was of a brown
colour inclining to 1
The large artery, from the heart ah, oil quite to the whole of the curva-
ture, was ve; ntly dilated, though not in any great d<
to the feptum tranfverfum it feem'd to be narrower than it naturally
Having laid it open ; and dii >d, which it contain'd in fome
conliderable quantity ; it fhow'd, on the whole of its internal furface, from
the heart at leaft to the emulgent branches, fome whitifh particles, and fome
lines that were a little protuberant: befides, not only in that tract which
I juft now fpoke of, but in other pares alfo, as I found from diffecYina-
io;\)c of its fuperior branches, the internal coat of this vcflel was fo eafily
to be disjoin'd from the next, that large pieces of it follow'd the fligluclt
friction of the fcalpel.
In the belly were the following appearances. The omentum was drawn
up towards the fplecn. The fituations of the inteftineswere difturb'd. And
thefe vifcera, but particularly the colon and the rectum, were much di (tended
with air. The melentery indec 1, the ftomach, the fpleen, and the liver, the
bladder annex'd to which was full of bile, were found.
But the pancreas, which, like fome of the fmall inteftines, was of a red co-
lour-, efpecirtily in its more deicending part •, had its glandular bodies firmer
than they generally are, and more diftinct from one another.
Finally, in examining the uterus, the tubes, and a confiderable part of
the vagina, with accuracy ; not only at that time, but on the day following
when they were taken out of the body, in order to give us more time, and
day-light ; we obferv'd thefe things.
To the pofterior part of the fundus uteri, externally, about the middle, was
hanging, by a fhort peduncle, a globular body, refembling nothing more in
whitenefs, form, and magnitude, than a fmall unripe cherry : in cutting of
which, we found it made up of a fibrous, but callous fubftance •, the orders
of the fibres being confus'd : another globe of this kind was buried within
the very thickneis of the parietes uteri.
The fundus uteri being open'd foon after, it appear'd to be fmear'd over
with a g'^at quantity of mucus which was fomewhat bloody : which being
wip'd off, and I having fliown, by prefiing my fingers underneath, that
bloody drops came out every where from the fundus, but not from the cer-
vix, and ftill lels from the vagina, with a very gentle prefiure ; it did not
fo much difpleafe Santorini, that we could not learn, for a certainty, whether
the woman had menftruated lately, as that he had before fuppos'd (#) the
fource of this difcharge to be in the vagina, rather than in the uterus.
The upper part of the cervix excepted, the remainder was ting'd with a
far different rednefs •, that is to lay, as if from inflammation, which on one
fide inclin'd more to a brown, and yet did not any where pervade the fubftance
of the cervix to any depth.
In the tubes alfo was a mucous humour, but white. Both of thefe canals
[x) Opufc. Medic. 4. n. 3.
were
638 Book III. Pf Difeafes of the Belly.
were pervious into the uterus, for air blown in by the larger orifice : nor
were hydatids wanting near to that orifice.
Both of the teftes were tumid from included cells : but one of them more
than the other; as befides one large cell, it alfo contain'd many fmallerones,
all full of ferum, except one which was fill'd with a white pus.
In the other, together with the cells, and the veficles, containing ferum,
we faw other cells of a black colour internally. And on the furface of both
we obferv'd orifices, which admitted a (lender probe : but particularly in the
membranes by which the tubes are connected with the teftes ; they are call'd
Alt Vefpertikonum, or bats wings •, w7e faw the plexuffes, and nerves running
in an elegant manner.
And as thefe were fome of the thicker ones which I had feen before ; fee,
faid I, this is the " plexus," and thefe the " nerves," which I have fpoken
of in the Adverfaria (y), and promis'd to defcribe more fully on fome other
occafion : this defcription was afterwards given by Santorini (2) himfelf, but
he muff, have totally forgotten this paffage of mine in the Adverfaria, when
he faid, that this plexus was either not clearly " known, or indeed not hi-
" therto obferv'd."
24. I am not willing to add long annotations to a long hiftory. Let it be
fufficient to fubjoin a few things, and thefe in a brief manner.
In regard to the fternum, therefore, being prominent in a certain place,
and the ribs, together with their cartilages, being de >refs'd inwards to fuch
a degree, on both fides, where they fuftam'd large breads, nd a thick fat;
a paffage of Riolanus {a) is extant, which refers to the fame thing : " in wo-
" men that have large breafls, and are fat, 1 found, upon removing the bulk
" of the breaft, the fternum accummated, and the cheft narrow ; which
" in them was the caufe of a dyfpncea : this narrownefs had been caus'd
" by the weight of the breads."
This laft circumftance is a doubt with me. For unlefs women lie, the
greater part of their time, in a lupine pofture ; which is not fo convenient
to thofe who are fat, and have large breafts ; the weight of the breads rather
draws the ribs outwards, than forces them inwards.
Neither can you impute it to the hard, and tight days, which women
wear ; for how can they hurt the ribs, without hurting the breads ? Where-
fore, I fhould rather choofe to account for this vitiated ftructore, from the
original formation : for it does not appear in 'thofe who arc i\\t, and have full
breads, but by diffeclion, wherein it drikes the eye, and the attention, of
the anatomid, much more than in lean perfons, (in whom if it be at all, it is
obvious before diffeclion) as it is an appearance which he does not expect.
But be this from what caufe it will, there is no doubt, but, by ftrcighten-
ing a part of the lungs, it may render the circulation of the blood throush
them, fo much the lefs eafy, and refpiration lefs free •, efpecially where from
cGnvuifion, or any other caufe, either of thefe offices is made more dif-
ficult.
And although it is very difficult in very fat and full-breafted women of that
kind, to ciidinguifh this dilbrder ; unlefs, perhaps, by preffing your fingers,
( f) T. i!. 14 in fine. [a) Enchsirid. Anatom. 1. 6. c. 14.
(: ) Obf. Anat. c. 11. §. 17.
very
Letter XLV. Article 25, 26. 639
very ftrongly, againft the cheft, at the fides of the breads •, yet if they are
affected with a much more difficult refpiration, than others of the fame make,
without any apparent caufe ; you may then fufpeet whi ther fuch a difeas'd
ftru&ure is not the cauie, in confequence of my obfervation, and thofe of
Riolanus.
And to thefe you may readily add an example, taken from the Commer-
cium Litterarium (£), of a noble woman afflicted with an allium-, among the
caufes of which, you will fee that a male conformation of the chelt is, with
juftice, recounted : for M the ribs, of the left fide, being curv'd like the
" Greek letter figma," made the cavity of the thorax narrow in a furprizing
manner; and deprefs'd the heart, which was longer than the heart of an ox,
into the right fide.
But as this woman " was very fat, and flefliy," it is mod probable that
this diforder, of the ribs, had lain hid under a great quantity or fat.
25. But, in regard to that fenfation of the ribs falling down, as it were,
to raifc up which the old women often fend for their fhe-phyficians, efpe-
cially in ibme particular cities •, as I remember formerly to have feen in mine •,
I confels I have nothing certain to fay upon the fubject.
Yet I nevertheless fufpect, that fome injuries, and uneafinefies, of that
kind which the cartilago xiphoides is wont to occafion, when verging in-
wards, are confounded with this fenfe : of which injuries, after Codronchius
(fj, and Septalius ( J), you may fee what is transfer' d into the Sepulchretum
from Diemerbroeck (e), from Barbette (f), and Bonetus himfelf^J: al-
though that even the cartilages of fome of the fpurious ribs, may now and
then be deprefs'd, and bring on confiderable inconveniences, which are, ne-
verthelefs, immediately remov'd by refcoring them to their former feat, and
that by the hands of an old woman, you will learn from the fame Sepul-
chretum (b).
But whether thefe cartilages belong'd to thofe " two lad" ribs, or to the
" laft of all ;" and not rather to fome one of them, that are next above the
two laft, the well-known fhortnefs of thofe lower cartilages makes me
doubt : and (till more, when I read that the " lower of them lay upon the
*' upper."
However, in the woman in queftion, whether the fenfe, whereof we fpeak,.
belong'd to fome caufe of this kind; or to another which I have explain'd
to you in the cafe of a woman formerly fpoken of (i) ; it is better to leave
quite undetermin'd, than to make any unadvis'd conclufion in this place.
26. But as to what relates to the flefhy fubftance, of the heart, dege-
nerating into a tendinous nature, you will, in the firft place, conceive from
thence, that it was not without propriety I formerly (k) fuppos'd this might
happen ; I mean when I was upon the fubject of explaining, in what manner
this fubftance is ibmetimes chang'd into that of bone.
o
(&) A. 1733. hebd. 37. n. 2. (g) In eod. Schol.
(c) De Probpfu Mucron. Cartilag. (£) L. 2. f. 1. in Schol, ad obf. 116,
(d) De Morbis ex Mucron. Cartilag. (/) Epift. 26. n. 25.
(/) Sepulchr. 1. 2. f. 1. in additam. obf. 11. (i) Epift, 27. n. 17.
(/) Ibid. 1, 3. f. 7. in Schol. ad obf. 19.
And
640 Book III. Of Difeafes of the Belly.
And that the force of the heart decreafes fo much the more, in proportion
as the greater number of its parts become tendinous, inftead of being flefhy $
it is natural to gather even from thofe things, which are faid in the fame
place (/;. *
Moreover, this force had decreas'd, in that ventricle which has need of the
greatc ft force, that is in the left; which, like the neareft part of the great
arterial trunk, had another dilbrder of dilatation.
Yet the woman had not complain'd of any violent pulfation of the heart ;
for Albertini (»/), even in aneurifmatic diforders, found the pulfation, " ei-
" ther quite inconfiderable, or much left than ufual, where the fubftance of
" the heart had become, quite from its bafis to more than one half its extent,
" either tendinous, as it were, in its confiflence and colour, or too flaccid in its
" nature •*' for there is no doubt, but the natural force of the heart muft
be debilitated, from either of thefe ftates.
However, in regard to all thefe diforders, and others, which I have de-
fcrib'd in the great artery, and the fubftance of the lungs being become ten-
dinous, as it were, in many places, and the coarctation of thefe vifcera, and
of the heart, by the depreflion of the ribs ; in regard to all thefe diforders,
I fay, you very clearly lee, that they might produce a fatal interception, both
of refpiration, and of the blood's circulation ; where a more violent convul-
lion, than ufual, of the nerves that go to thefe parts has come on.
27. That this convulfion had; as well as other more flight diforders, to
which the woman had been fubjecl ; its origin from the uterus, and teftes •,
the preternatural appearances which we faw both in the former, and the latter, *
and the fenfe of the uterus afcending, as it were, which began from thence,
fecm to argue.
For, although we did not find the uterus to have proceeded upwards, from
its natural fituation ; which indeed cannot happen ; yet we faw the inteftines,
which might be taken for the uterus, not only diftended with flatus, but
alfo remov'd from their natural fituations. And to thefe parts a convulfion
is eafily propagated, by the nerves communicating with thofe, that, bein"-
fubfervient to the functions of the tubes, and the teftes, were fcen by us in
the ate vefpertilionum in a thick ftate-, inafmuch as they are frequently dif-
turb'd by irritations arifing from the teftes.
Here you will perhaps fay : but much more confiderable difeafes, both of
the uterus, and teftes, are frequently found in other women ; who had nor,
neverthelefs, been afflicted with violent affections of this kind.
I grant it. Yet there is not in all a matter equally acrid, and irritating ;
nor are the nerves equally prone to receive an irritation in all, as they were
in this woman, who trembled from the flighteit occafion of fear : nor, final-
ly, are there in all, as in this woman, thofe diforders of particular vifcera ;
fo that if a violent convulfion make an impetus upon them, they have it not
in their power to refill.
For which reafon, we have the more to fear for thofe hymeneal, or hy-
pochondriac perfons, in whom we either know, or may with good reafon
(/) N. 18. (m) DeBonon. Sc. Inilit. in opufc. torn. 1.
fufpecl,
Letter XLVT. Article i. 641
lufpect, that there is either a very great acrimony of the humours, or a taint
of the principal vii'cera, at the lame time.
And as lbme phylicians, otherwiie not unlearned, did not attend furfici-
ently to this j I remember that a young man, who was hypochondriac, and
who had been accuttom'd, for a long time, to harafs their ears with exeef-
five, and continual complaints-, though for the molt part to very little pur-
pofe ; being feiz'd with a fever, which they, as ul'ual, paid but little regard
to, and made light of, was overcome by the infidious difeafe, and carried
off, before they, I do not lay foretold, but were fenlible of the danger.
You therefore, even in querulous pcrfons of this kind, will prelerve, ac-
cording to your cuftom, a cautious, and accurate diligence. For diligence
was never injurious, but negligence often is : and to this, if I may fay the
truth, it is to be imputed, for the moll: part, that " any uerfon dies, of whom
*' the phyfician was fecure (n)." Farewell.
(«) Celf. de Medic. 1. 2. c. 6.
LETTER the FORT Y-S IXTH
Treats of the Impediments to Venery, and of Sterility
in both Sexes.
ALTHOUGH that feci ion of the Sepulchretum, which immediately
fucceeds, I mean the thirty- fourth, comprifes not only what relates to
itenlity, but alfo what relates to falacity ; yet it is my intention to imitate
Bonetus in the former only, for in the latter I have nothing at hand to pro-
duce : and indeed I think that fome things produe'd by him might have been
better omitted.
For what does it contribute to falacity, that the right fpermatic vein, and
the left, both open'd into the emulgents(tf)? or at leaft that there were more
than two {b) ?,Efpecially as a lefs aptitude to venery is afterwards accounted
for, from their number being increas'd {<) ; and the generation of a cold,
and watery femen, is dedue'd from the influx of thefe veins into the emul-
gents (d).
(a) Obf. 1. §. 1. & 3. (c) In Schol. ibid,
(i) Ibid. §.&. //) Obf. 5. §. 3.
Vol. II. 4 N So
642 Book III. Of Difeafes of the Belly.
So, in like manner, what has the increas'd fize of the kidnies to do there-
with (e) ? Or the diminiih'd fize on the other hand (/) ?
It is true, I am not ignorant what was formerly faid of the office of
thefe veins •, and what has been contended for, in regard to the kidnies, even
by Bartholin himfelf (g). But as the former things have been already fet
afide, by the knowledge of the blood's circulation ; and as what relates to
the kidnies is exprefsly call'd " a paradox" by Bonetus (b) ; they mould ra-
ther have been hinted at in fome of the Scholia, than recited among folid
obfervations.
But I, moreover, think that in regard to fterility, or fcecundity, fome
things might have been left out with very great propriety. I will give you
two inftances.
A man who had fore'd a virgin, was entirely deftitute of teftes, both in-
ternally and externally (*) j the teftes therefore do not ferve for the genera-
tion of the feed.
Formerly, indeed, there might have been room for thefe things, when
that very opinion of Ariftotle, for inftance, which is there quoted, was em-
brae'd even by learned fectaries : among thefe I do not doubt to place Catul-
lus, whom the fucceeding poets have with juftice, call'd "Teamed," when
he writes thus of Atys (k).
Devolvit ilia acuta fibi pondera filice,
" He difencumbers himfelf of thefe weights by means of a (harp flint.'*
And now what has this comparifon, of tefticles with weights, to do with
the prefent fubjedr. ? Or what has this afiertion to do, " that none of the
" fpermatic veflels any where enter the teHes ?**
Or, finally, what affinity is there betwixt a virgin being fore'd, which may
be done by an eunuch, and impregnation, of which an eunuch is certainly not
capable ?
It is alfo worth while to pay attention to this circumftance, that, in a wo-
man (/), who " died from the exceffive ufe of venery, the round ligaments,
" in the part of them neareft to the uterus, were found full of femen."
There is no doubt but thefe things might have met with approbation for-
merly ; but they cannot meet with it now : no more than thofe things
that are advane'd in the preceding feftion (m), of the female femen being
found corrupted in the tubes, or in the uterus, and vafa deferentia.
But give, me leave now to omit thefe things, and produce thofe that are
more probable, in regard to the fterility of both fexes, and firft from Val-
falva.
2. There was a certain man who was dumb, yet not becaufe he was de-
ficient in his hearing; for he heard very well : the fame perfon had no hairs,
either on his face, or his breaft, under his arm-pits, or on the fcrotum ; a.
{?) Obf. 1. §. 5 & 6. (i) Obf. 1. §. 2. & Schol.
(f) Obf. 2. §. 1. (i) Carm. 62. v. 5.
{g) Vid. Adverf. Anat. 3. animad. 33. ad (/) Obf. 6. §. 6.
fin. {m) Obf. 4. §. 11 & !2.
(b) Schol. ad obf. I. §. 5,
Letter XLVI. Article 3, 4, 5. 64 j
few fcatter'd ones being fecn on the pubes only, at the very root of the penis.
This man was carried off by an accute fever, at the age of five and thirty,
his fever being attended with worms.
All the organs of generation being accurately examin'd, they flrow'd no
mark, of dileaie.
3. Whether this man had a generative faculty, or not, Valfalva has not
added ; nor yet whether he was without hairs quite from his birth : for the
celebrated Heilter (n) law a man, who, without any foregoing dilbrder that
deferv'd notice, had loft all the hairs in his body, and did not recover them
within ten years.
Yet it is to be fuppos'd, that he, of whom Valfalva left this account, was
not only naturally without hairs, but incapable of procreation ; lo that both the
circumftances led him tc undertake an accurate examination of all the parts
of generation.
And as there appear'd to be no diforder in thofe parts •, this obfervation
feems to hint, that the caufe, whatever it is, by which the femen is rendcr'd
fertile, and the body becomes hairy, mud exill in the invifible ftructure of
the parts which fecrete, or perfect, the femen.
And we, certainly, fee both of thefe circumftances happen together, at
the time of puberty, that is when thefe internal ftru&ures have now begun
to be fufficiently develop'd.
And indeed, lbme very flight appearance, in the cutis of women, has
fometimes been a proof to me of their fterility •, when this was from the
birth, and perpetual. For I have feen that two women, in whom there was
nothing at all that did not promife fcecundity, have been married to men of
excellent health, and yet been barren.
When I confider'd every thing very attentively ; I found the cutis, in one,
contrary to what we fhould have fuppos'd, from her kind of life, age, and
habit of body, to be by no means fmooth, and foft, if you touch'd it : and
in the other I found the fkin cover'd with a cuticle, which was continually
coming off in little fcales, and fcurf, even in the face. And I faw a third
barren woman fimilar to the laft when I was copying this letter.
And to me thefe things feem'd to admit of being accounted for, from the
febaceous glands of the fkin fecreting a matter, which is either lefs in quan-
tity than it ought to be, or not of the nature requir'd.
But how this matter, when retain'd within the body, or being lefs fit for
its office, fhould prevent conception, is uncertain. At prefent, however,
let us come to evident diforders, in the organs of generation themfeives.
4. Valfalva made obfervations upon two women who were barren •, though
in the prime of their life ; the one from having fcarcely any veficles in the
ovaries; and the other from the humour of thefe parts being quite con-
creted-, juft as if they had been boil'd upon the fire. But as I have given
you the hiftory of thefe, already, in other places (o), there is no need to
repeat them here. I go on therefore to my own.
5. I diffected mod of the parts of a man, who died in this hofpital, about
the latter end of November in the year 1717, with a view to anatomical
(») Eph. n.c. cent, i & 2. obf. 197. (0) Epift. 36.11. 17. & Epift. 20 n. 7.
4 N 2 inqui-
644 Book III. Of Difeafes of the Belly.
inquiries -, when I obferv'd that fome parts were in a preternatural ftate.
The ureters were wider than natural in fome places. And on one fide,
both the veficula feminalis, and that part of the vas deferens, which is next
to this vcficle, had fcirrhous parietes ; the membranous fubftance being al-
moft chang'd into a cartilaginous nature.
6. From this obfervation it appears, how much was wanting for the per-
fection and ejaculation of the femcn. For neither that which is wont to be
added, by means of Harderus's glands, or carried away by the lymphsducts,
could be here added, or carried away •, nor could the force, which the con-
trading coats of the veficles, and of the lower parts of the vafa deferentia,
previoully diftended with femen, exert on this fluid, where it is thrown out,
be at all expected here.
But 0:1 the other fide, you will fay, nothing of this kind was wanting.
Yet the quantity of inert, and watery femen, as it were, which muft flow
from the oppofite fide, was of great detriment to that very good femen to
which it was jom'd.
And indeed the hardnefs, and thicknefs, of the feminal duct, at its ter-
mination on one fide, may increafe fo gradually, as to prefs upon the extre-
mity of the other, and obftruct it.
And thus it was I remember, that I anfwer'd to Laurence Mariani, a gen-
tleman whom I have fpoken of before, when in the clofe of the year 1736,.
he wrote me the cafe of a noble youth.
This young gentleman having never had knowledge of any woman, his
wife only excepted-, by whom he had one daughter-, had afwelling of the
left fpermatic vefTels, attended with pain, together with a fwelling of the
epididymis, and the vas deferens ; which was perceiv'd to be hard, together
with the epididymis -, while the teflicle preferv'd its ufual foftnefs.
By means of fome remedies, which were applied, the pain was, after fome
months, greatly diminifh'd -, but the tumour and hardnefs not greatly.
Notwithftanding every thing on the right fide was, as far as we could
judge, in a found ftate ; and therefore very proper for the generation, and
conveyance of the femen ; the patient, neverthelefs, emitted none of this
fluid in coitu, to the great furprize of the phyficians.
However, you will have obfervations of a coalition of one of the veflels,
that carries down the femen to the veficle, and in like manner of a calcu-
lus concreted in one of the veficles, to add to the others-, of the former cafe
from Brunncrus (p) and' Waltherus (j) -, but of the latter from Valenti-
nus (r).
7. And I might here add what I have remark'd, in the difiection of bo-
dies, of the feminal veficles being dry, and wrinkled, even in a young man ;
and of the pafiage of the femen, into the" urethra, being become blind ;.
which Waltherus (s) alfofaw •, if I had not already communicated thefe things
to you, when treating of other diforders, and particularly of the virulent
gonorrhoea (7). And for the fame reafon I omit what relates to calculi
(p) De Gland. DuoJ. ubi de ear. in Mom.
Demonftr.
(y) Acl. Erud. Lipf. a. 1725. M. Novembr.
(/-) Eph. n. c. dec. 2. a. 6. obf. 68.
( s) Loco modo indie.
(/) Epift. 44. n. 7. & Epift. 40. n. 29.
Of
Letter XLVI. Article 8. 645
of the proftatc gland, that prevent the exit of the femen. For this you have
already had in the forty-let ond letter (u).
8. I fhould alio have written at large, in this place, of the great diforder
of the urethra, which I examin'd in a ruftic young man, together with my
celebrated collegue Vallifneri ; if he himfelf had not publifh'd the cafe three
years afrrr (.v), and the editors of all his works over again (y). Wherefore I
ihall only add fome few things.
As the fcrotum was not entirely divided into two parts ; but only anterior-
ly •, betwixt the upper parts of both theie divifions was the orifice of the
canal of the urethra: and from thence quite to the apex of the glans, through
the whole inferior furface of the penis, which was much fhortcr than is re-
prefented in the figure (2), not a canal, but a femicanal, was now continued ;
that is the upper paries of the urethra only and this fmooth and fhining ; lb
that you would find fomewhat lefs difficulty in giving credit tb the young
man, and to a woman, who faid that fhe had been wjth child by him : for
the former aflerted that when he made water with the penis a little rais'd, the
urine ran out through the femicanal •, and the latter that the femen, ejaculated
by him, enter'd the vagina, and was not loft.
At lead the urine, when he difcharg'd it againft the wall, we fawtoafcend
higher than the orifice of the urethra. Nor did it efcape us what the ftruc-
ture of the penis can bear •> and what de Graaf (#), and Harvey, whom he
quotes, had feen on this account; I mean that a penis "which appear'd
** very fmall, at firft fight," when it was inflated, " had ftretch'd itfelf out
11 into a large body, from being almoft hid : and that fometimes, " except
"• when it was excited by a tentigo, it had not been at all prominent in the
*' corrugated fcrotum, except in the extreme apex of the glans."
We therefore conceiv'd, that when this fmall indeed, but not very fmall,
penis extended itfelf; the young man at the fame time affirming it ; that part
thereof in which the orifice of the urethra was feen, was ftretch'd in its length,,
and by this means fufRciently enter'd the vagina-, and that, by the inferior
paries of this cavity, applying itfelf to the remaining part of the open ure-
thra, the femicanal was chang'd into a perfect canal : juft as happens to the
femicanals which I have defcrib'd in the Adverfaria (£), in the penis of the
tortoife, and the viper, when receiv'd in the genitals of their females.
Indeed I do not know, whether, in the infant of three months old, who
Palfin (c) has told us was feen by him, as the canal of the urethra terminated
in the fame part that it did in our young man, fo a femicanal was continued
quite on to the glans : but this I know, that if the conformation of that
child was the fame as the conformation of this young man, the prediction that
this difeas'd ftructure " would render him incapable of procreation, and
" caufe great inconvenience in the difcharge of his urine, is but little to be
" depended upon."
Yet I am not ignorant, that the ancient phyfkians, and furgeons, even in.
thole men, in whom the canal of the urethra is produe'd quite to the glans,
(k) N. 37. (a) DeViror. Organ, uhj de Nervof. Penis
(x) Eph. n. c. cent. 9. obf. 72. Corporib.
(_)) Tcm. 3. p. 3. n 28. (i) IV. Animad. 4.
(z) Cent. tit. tab. 2. fig. 1. (c) Anat, du Corps hum. p. i_. tr. 2. ch. 17,
e but
64.6 Book III. Of DUbafes of the Belly.
but opens beneath it •, who are for that reafon caliW hypcfpadi<ei \ have pro-
noune'd the fame thing, in regard to the faculty of generation : and this
opinion is confirm'd by the more modern authors, and particularly by Dionis
(d), where he points out fome caufes of this diforder, even after birth.
But I wonder neverthelefs, that, as they have read our Fabricius ; which
appears from their writings ; they have made no exceptions to fuch a predic-
tion •, but have afl'erted that the work of a furgeon is quite neceffary here •, as
he has exprefly admonifh'd us (<?), " that he had neverthelefs feen children,
" which had been begotten" by thofe, who were affected with this diforder j
■which others (f) alfo have confirm'd.
Wherefore, I the more commend Ruyfch, who •, having formerly fuppos'd
(g) that a diforder, not unlike that, for inftance, which I have defcrib'd,
" brought on an incapacity of procreation •" has fo moderated his affertion
afterwards (£), as to fay, " that thofe who labour under this diforder rarely
" impregnate their wives."
But to return to thofe in whom the urethra happens to be open in a great
part of it, and form 'd into a long femicanal; in the year 1756, before I re-
vis'd this letter, another ruftic young man, of two and twenty years of age,
was brought to me, who had the fame kind of formation as the other •, except
that the femicanal, at its beginning, was a little diftant from the upper part
of the fcrotum, which was cover'd with hairs, and had a confiderable divifion
into two parts.
In this young man, alfo, the urine did not fall down at his feet, but was
thrown againft the wall : and the penis, when diftended by a tentigo, became
from a fhort one, confiderably longer ; as he himfelf affirm'd.
And as this was confonant to reafon, fo the appearances •, and in particular
the length of the femicanal, which was but little lefs ; render'd it not at all
improbable, that this young man had, likewife, impregnated a woman ; as
both of them confefs'd.
Thofe who law, at Peterfburg ; many years after the publication of Vallif-
neri's obfervation and mine {t) j the urethra lying open after the manner of
a fulcus, or femicanal ; being folicitous about determining the fex (which
was an inquiry we had not the lead occafion to make) did not once inquire,
whether this ftructure could intirely take away the power of procreation.
And the celebrated Abraham Kaau Boerhaave, when he produe'd their ob-
fervations, flood up for our opinion -, which he feems not to have feen : for
which you will alfo fuppofe the celebrated Haller (k) to argue, where he
fpeaks of it in a curfory manner ; and fuppofe that he would have argued for
it in a boy alio •, in whom he faw a like deformity •, if he had feen him in an
advane'd age : for the boy was no more than three years of age, at the time
he examin'd him.
I do not refer to this clafs the obfervation of Salzmann (/), on a ruftic young
man, whofe urethra pafs'd not below, but above and betwixt the nervous
(d) Cours d'Operat. de Chir. Demonftr. 3. {b) Thef. Anat. 8. n 30.
(e) De Chir. Operat. ubideglande non per- (/) Nov. Comment. Acad. Sc. Imp. Petropol.
for. torn. 1. in Phyfic.
(f) Eph. n c. dec. I. a. 3. obf. 91. (A) Comment. Sec. R. Sc. Gotting. torn. I.
(£) Muf. Anat. thee. c. Repof. I. n. 1. (/) Aft. n. c. torn. 4. obf. 65.
and
Letter XLVI. Article 9. 647
and fpongy bodies, in an open (late, on the back of the penis ; becaufc here,
as the figures ihow (w), the penis was fo much the fhorter in proportion to its
thicknels, nor increas'd much from venereal ideas •, and alio becaule it was
a little curv'd downwards •, and lad of all becaule the urine did not flow out
with impetus through the urethra. On account of all which circumftances,
it was with juftice fuppos'd, that the young man was not fit for the propo-
gation of his fpecies.
9. And I judg'd in the fame manner of another young man, who was
thirty years of age, although he neither had the urethra on the back of the
penis, not the whole of it open. This man I carefully examin'd, as I was
requefted to do, and as the cafe itfelf requir'd, in the year 1738.
He was lefs robult than the other two, that I infpeded ; yet was pretty
healthy and well, except his eyes and his penis; the former of which were
blind from an old and conftant inflammation, and the latter was in the date
I mall prefently defcribe.
He himfelf readily acknowledg'd, that his wife was in the fame ftate of
virginity, in which he had married her three years before. He fuppos'd the
caufe to be, that the glans was curv'd towards the inferior part, and not per-
forated at the apex, but below •, and for that reafon obstructing both the en-
trance of the penis, and the ejaculation of the femen.
After hearing thefe things, I examin'd the genital parts, and found them
in the following ftate. The teftes were large : the fcrotum was not pale in-
deed, but very lax: the penis was of a proper proportion, both in length, and
thicknefs : the preputium was of the fame kind that I have defcrib'd in the
two other young men, fimilar to the praeputium clitoridis : for it fufficiently
cover'd the upper furface and fides of the glans ; but was deficient on the in-
ferior furface.
And on the whole of the fame furface of the glans, and for a little fpace
below the glans, the inferior paries of the urethra was alio wanting ; fo that,
like a femicanal, only the upper paries continued to the extremity of the
glans ; being fmooth and of a nightly red colour, and in the middle, in a lonr-
gitudinal direction, {howing very clearly three orifices, of the larger canals,
which I have fpoken of in the Adverfaria (n) ; being in the form of an
ellypfe-, orifices of which kind, and more indeed, and thofe fomewhat larger,
we had feen in the firft young man in particular ; whereas in none of thefe
did any fmall foramina of the leffer canals appear, though fought after with
attention : for I do not doubt but the figure, which 1 have refer'd to above
(0), was defcrib'd from memory •, as, befides orifices that pals in one right
line through the middle, it reprefents fo many other foramina, here and
there, at the fides.
Moreover, the orifice of the canal of the urethra, in this young man of
whom I have begun to fpeak, was in that part, from whence I have faidthat
the femicanal began : and a very litrle below that, the inferior paries of the
urethra was perforated with another lefler orifice : and the young man faid
that urine came from both of them ; and that he had heard from his mother,
that .he was born with this conformation.
(«) Tab. 6. fig. 1. & z, («) I. n. 10. (0) Ad n. 8.
5 Then.
64S Book III. Of Difeafes of the Belly.
Then inquiring into the caufe of curvature in the glands, when I faw that
the ikin was pretty lax, which adher'd to that part near to the orifices where-
of! have fpoken ; and not tenfe and contracted lb as to curve the gUns ; i
inqmr'd whether, when the penis was turgid, the glans was turgid alfo-,
and whether, at that time at lead, any troublefome fenfe of tenfion was per-
ceiv'd ; and particularly at the place of the fkin's adhefion jult now pointed
out. To both of which he anfwer'd in the negative.
He only added this, that in his early puberty, when the penis was tumid,
this troublefome fenfe had been perceiv'd in that part-, but after a few years
having pafs'd was perceiv'd no more : and although, when he married his
wife, the glans fometimes fwell'd together with the penis, yet from the time,
that, in making vain endeavours to enter the vagina, a great quantity of
fcoaen had been pour'd out with great quicknefs -, from whence he faid
that his opthalmia became more flight, and his fight lefs dull •, the penis only
became tumid, and the glans hung down flaccid, and without any voluptuous
inclination.
It was evident that what he could not perform with a tumid glans, it was
impoflible for him to do with it flaccid. And the reafon why it had formerly
been flaccid in general, and was always fo now, I fuppos'd to be that male
conformation of the urethra, which I have now defcrib'd.
For, as the inferior paries of this canal was wanting in that part, where it
is wont to be increas'd by a pretty thick corpus fpongiofum dilating it-
felf to make up a confiderable part of the exteriors of the glans ; it is to be
fuppos'd that the blood, which is protruded upwards for the proper diften-
tion of the glans, muft have had a lefs quick palTage thither : and this con-
jecture was confirm'd to me, by the fame fpongy body of the urethra; as
from thofe two orifices, quite to the root of the penis, I obferv'd it to be
thicker than ufual in this young man ; without doubt from the blood not
having a free pafiage into the glans, and therefore being collected below it :
jo that, in proportion as it added thicknefs to this fpongy body, fo much
did it detract from the length, and by this means curve the adjoining glans
downwards.
But none of thefe circumflances took place, in the other young men whom
I examin'd •, becaufe that body extended its inferior paries, not at all, or but
juft above the fcroium •, and the fuperior paries, or that which is receiv'd be-
twixt the nerveo-fpongious bodies of the penis, was certainly very thick, as
happens in fome perions, fo that it could fufficiently communicate with the
glans.
You will perceive this, in fome meafure, from the figure given by Ruyfch,
which, in his century of obfervations, is mark'd feventy-fix: and thofe things
that I conjedtur'd in the young man laft defcrib'd, you will conceive of far
more clearly, from the eighty-firft, and eighty-fecond figures, of the fame
century, when compar'd with the feventy-rifth.
10. By the feveral things which have been jufl: now faid, you fee that what
the more modern phyficians, and Boerhaave, in particular (p), have taught
very clearly ; from confidering the ltruclure of the penis with great accuracy ;
are confirm'd: i mean that the corpus fpongiofum urethra, and the glans,
(p) Pradeft. ad Intu't. §. 6;±.
may
Letter XLVI. Article n. .649
may be tenfe and tumid, while the corpora penis remain flaccid, or are even,
abfent ; tor lb our Plazzonus (q) law it; and on the contrary it may happen,
that the glans may remain flaccid] while thefe bodies of the penis are dil-
tended : tor in either the one or the other way, the bufinefs of generation may
be injur'd.
Moreover, there are many and various impediments to diftention ; juft as
there arc many and various caules of this diftention. Among which caules,
not only the real, but the" apparent, plenitude of the vcficulas feminales, teems
proper to be plac'd.
I call it apparent at that time, fince there is not lb much femen in the vefi-
cles, as they can really contain at another time ; but as much as they can con-
tain at that time.
Thus, upon waking in a morning, even fome old men are fenfible of a ten-
tigo, which they immediately get rid of by difcharging their urine. For
the urine diftended the bladder, and this comprefs'd the fubjected veficles ;
but particularly by that bafis of it which extuberates on the back-part, and
which I have fpoken of; fo that, by this means, their capacity being dimi-
nifli'd, they were juft as much diftended, even with a fmall quantity of fe-
men, as they would have been with a great quantity when not comprefs'd.
And indeed the moft experiene'd phyficians, and among thefe Gulielmus
Ballonius (r), have taken a very ufeful hint from this phenomenon. Let
him who is not very potent in his generative faculties, fays he, " perform
*' copulation after much titillation, with his urine retain'd, and having a
" great defire to difcharge it."
So what the fame perfons have obferv'd after Galen (j) ; that among the
marks of a ftone in the bladder, the penis fometimes " is immoderately
" tenfe -," we mall account for in the fame way : and efpecially where there is
a very large calculus.
And I have faid in the fame way, without being ignorant that thefe phe-
nomena may be explain'd in other ways alfo. Yet there are cafes in which
one explication may be preferable to another : and, indeed, it may even
ibmetimes happen, that many caufes, of the fame kind, may confpire to pro-
duce the fame effect.
1 1. But of men I have fpoken fufBciently. Now let us pafs on to women;
beginning with two, whole genital parts I was requefted to examine with ac-
curacy, in the fame manner as thole of the three young men mention'd
above.
One was a ruftic woman, whofe pudendum was in a perfect and natural
ftate. But that canal, as they call'd it in the time of Celfus (t)> into which
it opens, and which we now call the vagina, had fcarcely run on more than
a third part of its proper length, when it fuddenly terminated in that part.
There was no cicatrix at that place, nor below it : the woman herfelf, or
her parents, could none of them call to mind any ulcer, or any other preceding
dilbrder, in confequence of which the fides of the vagina might have coalelc'd ;
for if thefe parts are ulcerated, either from the lues venerea, from a difficult
birth, or from any other caufe whatever, where the careleflnefs of the fur-
(y) De Partib. Generat. 1. i. c. 21. (s) De loc. aff. 1. i.e. 1.
(r) L. 2. Confil. Med. 26. (/) De Medic. 1. 4. c. 1. ad fin.
Vol. II. 4 O geor,
650 Book III. Of Difeafes of the Belly.
geon, or the midwife has co-operated with the diforder, how eafily the fides
of this canal may grow together we are taught by many examples ; fome of
which will be pointed out to you by Marcellus Donatus (u) : and others I
fhall take notice of below.
However, not only nothing of that kind had preceded in this woman ;
but every part moreover •, being fmooth, fhining and equal, when you had
open'd, and dilated, that part of the vagina which there was •, appear'd in
fuch a manner, that you might plainly perceive not only the fides of this canal
to be in their original ftate •, but that the part by which they were bounded,
was a kind of roof, or ceiling, form'd by the firft inftitution of nature ; being
of the fame ftructure, and made up of the fame fubftance. Nor indeed did this
roof or ceiling in the lead give way, either to the finger when prefs'd againft
it, or to the penis of the hufband ; which had now, for three years fpace, been
frequently forc'd againft it. For it was not like a membrane which was
drawn tranfverfly •, but refilled like a very folid and thick paries.
Having remark'd thefe things, I inquir'd of the woman •, who was as yet
in the flower of her life, and enjoy'd perfect health ; whether fhe, like other
women, did not perceive blood to flow from thence fometimes, if not every
month ; or, at leaft, if, at certain intervals, pains did not arife about the
loins, and the pubes •, but fhe anfwer'd to all thefe things in the negative :
fo that I began to fufpect the fame thing as in the fecond : and after defcrib-
ing to you her cafe, I will communicate my fufpicion to you.
12. This fecond woman related, that fhe was not indeed imperforate, but
had fo very narrow an aperture, that an eminent phyfician in a city of great
learning, who was at the fame time a furgeon, having examin'd her in early
puberty, advis'd that this aperture fhould be gradually dilated, by introducing
fuch things as were proper for that purpofe ; but that every thing elfe a more
mature age, and a hufband, if fhe fhould marry, would accomplifh.
She likewife faid that fhe had introduc'd fomething of the kind recom-
mended at fometimes, and in fome meafure-, and had by this means a little
dilated the orifice of the foramen ; but could bear no farther dilatation : that
her hufband alfo, to whom fhe had been married three years, had by fre-
quent attempts fomewhat more inlarg'd the fame orifice ; but never could
enter it.
After hearing this relation, I infpected the parts with this intention, that
if a pretty thick hymen, or one that open'd by a very imall foramen, were
the obftacle, I would perfuade he* to undergo the incifion, as other practi-
tioners have done, and among thefe Blafius (x) -, but if the ftricture went very
high up into the vagina, that I would confider what, and how far any thing,
was necefTary to be done •, for the celebrated Benevoli had not as yet given
his example of an equally eafy and fuccefsful cure (y), to ferve as a pattern
for our imitation ; as his obfervations did not come out till many years after.
For the method of cure which is given us by Blafius (2), as perform'd on
a certain woman, to whom this had happened from child-bearing, was too
ievere •, not to fay, that, on account of the inteftinum rectum being wounded,
it was very long in being compleated.
(*) De med. hift. mirab. 1. 6. c. 2. (y) Oflervaz. 2.
:'v) Part. 2. obf. med. 6. {z) Part. 2. cit.obf. 7.
2 And
Letter XLVI. Article 12. 651
And that the woman being at length made pregnant, as happen'd to hei
whofe hiftory is given by Antonius (a)> the vagina might be dilated even by
utero-geilation itlclf, I was rather cautious of fuppofing ± as I confidcr'd this
in the number of very extraordinary inllances. .
And you will, at lead, fee that the fame thing did not happen to another
woman, who is Ipoken of in the fame books (b) ; anil you will alio fee with
how much labour, and if you attend to what follow'd, with how much dan-
ger likewife, Benevoli (f), together with Querci, was oblig'd, during the
pains of child-bearing, to dilate the vagina, which was contracted for half its
length, by reafon of a wound which had been receiv'd in childhood j whereas
thofe two may leem to have been born thus.
Thefe five women, however, had, all of them, a fmall foramen, through
which there was fome pafiage to the uterus : fuch as I alfo fufpedled there was
in her whofe hiftory I have begun to defcribe.
But when I law the foramen, of which the woman had fpoken, I imme-
diately knew that it was the orifice of the urethra out of its fituation ; and that
thanks ought to be given to God, that the woman could not fuffcr any far-
ther dilatation of that pafiage-, as, if fhe had, the confequence, without doubt,
would have been, that fhe could never have retain'd her urine.
From whence you perceive, that fo great a want of anatomical knowledge,
as not to diftinguifh the orifice of the urethra, to the great detriment, or at
leafl to the danger, of the patient, is not only found in vulgar furgeons
and barbers ; of whom fome fimilar inftances are related by Platerus (d), and
Peter de Marchettis (<?) •, but alfo in phyficians of eminence : unlefs it is more
proper, in this cafe, to accufe either the hade of the examiner, or the pre-
judg'd opinion that he had form'd to himfelf, from what had been improperly
related to him of a narrow foramen.
Then turning my eyes to that part of the genitals, which follows next be-
hind this orifice ; that is to fay, in which the orifice of the vagina is wont
to open ; not the fmalleft foramen, nor perforation, appear'd any where to
the inquiring eye, though never fo attentively applied : this place was in-
tirely fhut up, not with a membrane which would yield to prefiure, but
with a very firm and folid paries.
As I was in doubt what advice in particular to give ; for the queftion was
not here of " the genital part being concreted," as in Cornelia the mother
of the Gracchi (f), that is, of the edges of it " being agglutinated to one
" another," as Celfus fays (g), or of " a membrane plac'd at the opening of
" the vulva" which the fame author takes notice of (b) (the methods of cure
in which cafes are neither unknown nor difficult) but of a cafe which call'd
to mind one that I had read in Nabothus (z), of a phyfician endeavouring to
remove, with the knife, a coalition of the vagina, which had likewife been
from the birth, but being oblig'd to defift from his attempt, when he U\k
that the coalition was continued up very high, and that the large fanguife-
(a) Hift. de l'Acad. R. des Sc. a. 1712 obf. (e) Obf. Med. Chir. 60.
anat. 2. (f) Apud.Plin. Hill. Nat. 1. 7. c. 16.
(k) Hift. a. 1748. obf. anat. (g) De Medic. 1. 7. c. 28.
(c) Offervaz. 5. (/;) Ibid.
(i) Obf. 1. 3. ubi de part. Procid. (;') Difput. de Sterilit. Mulier. n. 7.
4 O 2 rous
652 Book III. Of Difeafes of the Belly.
rous veffels appearM •, and alfo brought to my thoughts the opinion of Na-
bothus (£), that " if there be a flefhy interftice," by which we muft under-
fland a pretty thick one, " it is better to abftain from the incifion of it,
" partly on account of the very great haemorrhage, and partly on account of
" the inflammation that would follow:" as I was turning over thefe things
in my thoughts then, it very properly came into my mind, to afk the fame
queftions that I had afk'd of the former woman (/), whether any mcnftrual
blood had ever been excreted ? Whether fhe had any uneafmefTes at inter-
vals in the loins, or the pubes ?
For, from the time of Ariftotle's havirrg faid (?»), " that in fome women
" the os uteri, being comprefs'd, and incorporated with the other parts, had
" continu'd in this flate from their earlieft time of life, quite to the time of
" their catamenia •, but that, foon after, the menftrua coming upon them, and"
" they being troubled with pain, this coalition was fpontaneoufly ruptur'd in
" fome, and in others cut alunder by the hands of the phyficians ;H I well
remember'd how many, and what kind of, evils, a number of women had
fuffer'd from the menftruous blood being collected in the vagina, and the
uterus i till the furgeons before and after our Fabricius ab Aquapendente(»),
reliev'd thefe diforders by cutting the impervious membrane, at the orifice of
the vagina : for that Fabricius mould have doubted (0), whether this was
what Ariftotle meant by the os uteri in that paflage, I am greatly furpriz'd ;
as if the occlufion of the orifice, of the vagina, might not be fo great fome-
times, that, whether the obstructing membrane be " violently ruptur'd," as
Ariftotle fays, or as Fabricius fays, cut afunder " in fome women," as the
former had immediately written, death might be the confequence of it ; for
that this may be the confequence, you even fufHciently conceive, from what
I have juft now hinted on the fubject.
And how many, and various, diforders thefe women had fuffer'd before
their cure, we may learn, by examples, from Donatus (/>), from Severinus
(q), from the two Fabricii, both ours (r), and Hildanus (j), from Ruyfch (/),
and from Nabothus («). To which you will moreover add thofe that other
authors, and among thefe the celebrated Fantonus (*), and KannegiefTerus
(jy), have defcrib'd.
For Benevoli, who had cur'd three patients of this kind, by reafon of his
mentioning the cafes in a curfory manner (z) only, has omitted to add, with
what diforders they had been previoufly affected.
Nor indeed, have thofe women only, who were born with an occlufion of
their vagina, been fubject to thefe diforders ; but thofe alfo in whom the ori-
fice of the vagina had grown together, after a difficult birth : to which kind
(A) Ibid. n. 23. (>■) Loc. cit-
(l) N. n. \s) Cent. 2. Obf. Chir. 60. exempl. 3.
[m) De Generat. Animal. 1. 4. c. 4. fub. (/) Cent. Obf. Anat. Chir. 32.
fin. («) Difp. cit. n. 4.
(«) De Chirurg. Oper. ubi de Hymen* im- (x) Opufc. Med. in Schol. ad Patris, obf..
perfor. 30. n. 3.
(0) C. feq-. (y) Aft. n. c. torn. 6. obf. 88..
(p) C. fupraad n. 11. cit. (zj Oflervaz. 1..
(q) Chirurg. Effic. P. 2. ubi de Section, c.
2 Of
Letter XLVI. Article 13. 653
of hiftorics you will add that which you find taken notice of in the Com-
mercium Litterarium («),
For when there is no perforation at all (from what caufe ibevcr this may
be) through which the blood Bowing together within the uterus may be dii-
charg'd-, this retain'd fluid mull, of courfe, produce confiderable diforders.
But if there be any foramen, luch women are not to be confider'd as quite
imperforate ; nor is it to be wondcr'd at if fome of them become impu
nated : as of thole five,' whole very great narrownefs of vagina I fpoke or
juft now, three actually were-, as another was alio, whole cafe is defer ib'd by
Hildanus (b) ■, \ , in the membrane that Quit up the vagina, there were
fome very lmall foramina.
Wherefore, in all thefe women, the menftruous purgations were difcharg'd
by the natural paflages, though thefe paflages were very lmall : and if thiv
circumftance were inquired into by fome perfons, who had it not in their
power to inlpect, thefe paflages, but only to learn from the hufbands
of the women, that their wives were impervious to them; it would be
a fufficient teftimony, to prevent them fuppofing, that, when thefe women
became pregnant, this mult have happen'd without the admiflion of the fe-
tnen virile : and we fhould, perhaps, have fewer examples, in books, of wo-
men being quite imperforated, than we have at prefent. But as thefe women
were not without their menftrual purgations, fo they were free from the dif-
orders which we have faid that blood collected in the vagina and uterus muft
of courfe bring on.
Having then confider'd all thefe things, and hearing, not only that nei-
ther of thefe women, whom I examin'd, had ever had any menftrual purga-
tion, but not any uneafinefs or pain tending thereto, nor even the flighted be-
ginning of them •, and on the other hand, feeing that both of them were
endow'd with very good health, colour, and ftrength -, as every healthy wo-
man is at that time of life which may yet be confider'd as the prime ; I be-
gan to fufpect, that, as they were without a continued and open canal, or
orifice of the vagina, they might, perhaps, alfo, be without a uterus, from
the original formation : fo that if the obftacle could even be remov'd by the
furgeon's knife, there would, neverthelefs, be danger, left the bladder, or
fome one of the inteftines, lying in contact therewith, in confequence of the
uterus being abfent, fhould be piere'd through at the fame time; in the fame
manner as there was a very confiderable danger, of this kind, in infants (of
whom I have already fpoken (c) ) who had the anus imperforate, and, at the
fame time, a total deficiency of the inteftinum rectum.
I therefore perfuaded both thefe women placidly to fuffer a marriage, which
was improperly contracted, to be diflblv'd ; rather than imprudently fubmic
themfelves to the incifion.
13. Nor would I have you object to me that there have not been want-
ing, nor are at prefent wanting, women who live in very good health with-
out any menftrual purgations : for I confefs it, and even know fome fuch
(a) A. 1754- hebd. 25. ad finem. (<-) Epift. 32. n. 3..
(£) Obf. 60. cit. exempt. 2.
myfelf ;
654 Book III. Of Difeafes of the Belly.
myfelf ; but I have often had the fame doubts in regard to them, that I have
had in regard to the two whofe hiftories I have defcrib'd.
Yet you will fay ; there are many who have born children, and, neverthe-
lefs, been without thefe purgations. But take away, from the number of
them, all thole that live in a climate far different from ours : take away thofe
that they call viragos : take away even thofe who do not enjoy perfect health -,
and you will find that thefe many will be redue'd to a very few.
Yet even upon this fuppofition, you will fay, there are more in number,
than of thofe who are born without a uterus. And I would confefs this
comparifon to be properly made, if it were as eafy for phyficians to obferve
the number of the latter, as it is to obferve the number of the former.
For the former, of themfelves, fpontaneoufly declare it, inafmuch as it is
a circumftance-, if you confider the fex in general, and the regions of the
world, in general, that are not very remote ; which is certainly very rare and
furprizing.
And out of all the others, who, compar'd with thofe very few, are fo
many the more in proportion ; I mean out of all thofe who live in good
health, without thefe purgations, but never bear children, how many of their
bodies have been difiected after death ? And unlefs you difTect them, certainly
neither they themfelves, nor any one elfe, can inform us, whether they are
furnifh'd with a uterus, or not.
Since, therefore, it is impoffible to know either cafe for a certainty •, who,
that is a prudent man, would be fo bold as to undertake to remove an ob-
ltrudtion of this kind, that he may happen to meet with, in like manner as
he would, if he were certain that there was an uterus within -, when, at the
fame time, the operation is neither neceflary to preferve life, nor to remove
any difeafe ; and perhaps not only without any advantage, but even dange-
rous ; especially if the obstruction be fuch, that either its fituation, or its
thicknefs, and hardnefs, mow it not eafy to be remov'd, and not without
great danger ?
I know of two women (for I have not the book, by me, in which the third
is fpoken of, who is refer'd to by the celebrated Cafpar Bofe (d) ; but I read
of a fourth (e) who was imperforate, and without any traces of a vagina, yet
not without fome flight, though ulelefs, appearance of the uterus) ; I fay I
know of two women, whom anatomy has fbown to have been born without
a uterus •, the one difiected by our Columbus (f), the other by his celebrated
fellow-citizen Fromondus (g) ; fo that this very circumftance is a proof to
me, that many more of thole who never have had any menftrual difcharge,
might have been found, by anatomifts, to be without any uterus: for though
this may feem to be very extraordinary, yet it muft feem much more extraor-
dinary, that if there had been no other inftance of the kind, both of thefe
Ihould have happen'd to be met with by anatomifts of Cremona.
As in both of thefe women the uterus was wanting, fo alio an open paf-
fage, that led to the feat of the uterus, was wanting ; fo that you may com-
pare the firft, in whom there was only a portion of the vagina, with the for-
(J) Difp. de Obfletric. Errorib. & est. §. 7.
in fin.
(e) Difp. Anat. ab Haller. collect, tom. 5.
p. -227.
(f) De Re Anat. 1. 15. in ipfo fine.
(g) Impeilor. Mulier. & can. Obfervat.
mer
Letter XLVI. Article 14. 655
mer of tlie two that I examin'd j and the other, who had the orifice of the
vagina imperforate) with the latter of thofe that I infpecteJ.
If any l'urgeon had attempted to open the paiVagc, in that body feen by
Columbus-, he would, at the lame time, have cut into fome vifcus, that was
contiguous to the fund of that vagina-, from the compreflion of which vifcus,
it, -perhaps, was, that the woman " complain'd in a furprizing manner, when-
" ever lhe copulated with her hufband."
If any perfons had undertaken to cure with a knife, that woman feen by
Fromondus; they would, firfh indeed, have met with a feptum which was
ftrong and firm, " and fo interwoven with folid fibres, as to approach nearly
" to the nature of a cartilage."
And while this was cut through, which would necefTarily require fome
force, nothing could more eafily have happen'd, than that, while they fup-
pos'd themfelves at the entrance of the cavity of the vagina, they fhould
wound the parietes of that cavity, which had coalefc'd with each other; anel
perhaps even the rectum inteflinum, which lies in contact with them, or the
urinary bladder.
Finally, thefe parietes muft have been feparated. And who can take upon
him to fay, that none of thefe circumftances were to be apprehended, in
the women infpected by me? Nobody certainly-, nor yet that the uterus was
not wanting in thefe, as it had been in thofe who were diflected.
Befides, the uterus is fometimes fo fmall, even in adult women, as to have
the fame effect that the abfence of the uterus would have : which I mail
confirm below by my own obfervation (b) ; if, as I have already fpoken of
the external orifice thereof, that is the orifice of the vagina, being fhut up,
you will firft give me leave to add a few things, in regard to its os inter-
num being obltructed.
14. Mention is made of the os uteri being fhut up, in more than one of
the books of Hippocrates (J). The caufts of this occlufion maybe many
and various : the greater part of which have been examin'd by Vallifne-
ri (£), who divides them into the external and internal. Let us confider
fome of them.
Among thefe they plac'd formerly, with Hippocrates (/), " the omentum
•' comprefiing the os uteri," in very fat women. And in what manner Ve-
falius explain'd this, you will learn, fomewhat more at large, from the Se-
pulchretum (m) ; for Vefalius himfelf contracted that paflage (») in his later
editions.
Without doubt this excellent anatomifl faw, on the one hand, how foftr
the omentum is, and, on the other, how thick, and capable of refinance,
the parietes of the ofculum uterinum are.
He therefore conceiv'd the omentum to defcend fo far betwixt the bladder
and this orifice, that, by preffing the foft parietes of the vagina, at its upper
part, one againft another, it might fhut up the paffage, for the femen, to
{h) N. 20. (!) Sea. 5. aph. 46.
(i) De Nat. Muliebr. n. 3 3 ; de Morb. Mu- \m) Sedt. hac 34. obf. 4. in Schol. ad §. 4.
liebr. 1. 2. n. 50 ; de Sterilib. n. 1. & caet. (») De Corp. Hum. Fabr. 1. 5. c, 4.
(i) lit, della Generaz. p. 3. c. 1. n. 5. &
feq-
the
656 Book III. Of Difeafes of the Belly.
the neighbouring os internum, by its bulk, and weight •, fo that the penis
when introduced, efpecially if pretty fhort, or languid, could not reach to the
upper part of the vagina, nor be able to diftend it.
Which explication of Vefalius, I can with lefs difficulty admit, than fuffer
that fome of the more modern anatomifts fliould follow the naked dogma of
Hippocrates : although I cannot conceive of the omentum, as lying betwixt
the upper part of the vagina and bladder, unlefs we fuppofe the cellular con-
nexions, which ufually are feen betwixt one and the other, in that part ; and
even fometimes a little higher ; to be torn through : which connexions, as,
in very fat women, they are themfelves ftuff'd up with fat alfo, may not,
perhaps, yield fo eafily, and give place to the weight of the omentum.
And as, in women of this kind, all the cellular membranes are diftended
with fat ; it is natural to conceive, that, from the neighbouring inteftines be-
ing very fat, or from fat being accumulated in the membranes of the Fallop-
pian tubes, in their fimbriae, or, at lead, in the membranous ligament which
they call the alee vefpertilionum, all thefe parts, or fome of them, may be
obftructed in their motions necefiary to generation •, for thus I choofe to in-
terpret Vallifneri (c), oratleaft to add fomething to his explication.
15. And among the caufes which obftruct the os uteri, the fame author
fuppofes, together with others, excrefcences form'd in the cervix uteri (p) ;
and with Hippocrates himfelf, (tones alfo(^). The oblervations that I have
made upon excrefcences I defer to the next letter.
Calculi I have never yet found in the uterus : which, however, I know
have not only been feen formerly in that place, by others, but even in my
own memory •, and thefe hiftories are refer'd to by Vallifneri.
But I could wifh that he had read many, and even all, of thofe that are
collected by Schenck (r) •, as, in another place (s), he has with difficulty
granted this : " that it is not improbable, but even (tones may be, alfo, ge-
nerated in the uterus."
For by reading over thefe hiftories, and by adding others moreover ; as,
for inftance, that you meet with in Bartholin (/), and in like manner that
which you have in the Sepulchretum (u) ; he would have understood very
clearly, that (tones had been actually found, in the very uterus of women,
after death, fo many times, and by fuch men, that it was not at all ne-
cefiary to fufpect, that if any calculi were laid to have fallen, or been taken
out, from the uterus of living women (as, for inftance, in that fervant-
maid Lariflzea fpoken of in Hippocrates (*)), they had been difcharg'd from
the bladder; notwithftanding no particular fymptoms of a (tone form'd in
the bladder, did now exift, or had preceded ; rather than from the uterus.
16. Moreover, among the internal caufes that (hut up the os uteri, is the
conftriction, or conglutination, of that orifice, examples of which you will
find produe'd by the celebrated Haller (y) ; whereto you may alfo add others :
(0) N. 5. cit.
(p) Ibid. n. 6.
(y) Ibid. n. 7. &c. 2, n. 42,
(r) Obf. Med. 1. 4. prope fin.
(s) Opere t. 3. p. 3. n. 12.
(/; Cent. 4. Hift. 64.
{u) L 3. f. 24. obf. 18. §. 10.
(x) Epidem. 1. 5. n. 12.
(y) AdPrxieft. Boerhaav. ad Inftit. §. 675.
not. ;'.
as
Letter XLVI. Article 17. 657
as thofe of our Fabricius ab Aquapendente (z), and the very ' ; ri
nevoli (a); from whole observation you may fufpecl, that, befidi s the conftric-
tion, there was, perhaps, fome membrane, which lhut up the os uteri, even
from the original formation.
And indeed the fame Fabricius (b) fays, that he, by introducing his fin-
gen into the vagina in the living body, had obferv'd " the membrane which
** forms the vagina, to be continued through the whole, and conceal the ori-
" fice of the uterus :" and Littre (c) faw, in the defection of a barren wo-
man, the membrane that inverts the vagina, internally, adhering to the os
uteri in the fame manner as it did to the furface of the vagina •, by which
incurs that orifice was (hut up.
Buc -Hippocrates did not doubt (d) that a membrane might " grow out
" over this orifice," even after birth. " When a woman cannot admit the
** male femen, it cannot be," lays he, " but that a membrane muft have
" grown out over the ofculum uteri." What I have feen of this membrane,
the following obfervation will (how you.
17. A woman of fifty years of age •, who was fo lame that the lower limb,
on the fight fide, was fhorter by four fingers breadths, than the left; died
of an afthma in the hofpital, about the latter end of January in the year 1747 :
at which time I was teaching anatomy, as ufual, in the college.
The cheft was very narrow, and when open'd fhow'd water to be containV.
therein : other circumltances they did not inquire into, as they were in hafte,
and felicitous about nothing elle, but to take out, with accuracy, the parts
which are form'd for the fake of the urine, and for generation, and to bring
them to the college.
I examin'd the parts deftin'd to both thefe offices with attention. In the
former, after having leen the arteries which go off from the annex'd large
trunks, and the iliac veins, to be more (lender on the right fide, than on the
left •, I obferv'd the kidnies to be not fmall, when compar'd with the ftature
of the woman which was of the loweft : thefe kidnies were found neverthe-
lefs, as far as I could judge : fo alfo in the bladder, the lower part of which
appear'd to be affected with a phlogofis, I remark'd that the orifices of the
ureters were fomewhat larger than ufual.
In regard to the genital parts •, to pafs over what does not belong to this
place, and in particular the hymen, and other things, which (how'd the woman
to have been a very perfect virgin, contrary to our expectation ; firlt, out of thefe
things which I had it in my power to obferve without dillection, there was
the fame phlogofis in the hymen only, and the neareft external furface of the pu-
dendum ; and from this furface, likewife, arofe very fmall preternatural tuber-
cles, which were in like manner red : and there was a phlogofis alfo in the
Falloppian tubes, and the alas vefpertilionum : but the teftes were fcirrhous,
and of a furface that was divided into a kind of fquares, or chequer-
work.
•(*) De Chir. Oper. ubi de Vkiis<juor. cauf. (cj Hift. de I'Acad. R. des Sc. a. 1704. ob-
Fu:minje concubit. non admit. ierv. anat. 13.
fa) Offervaz. 1. (d) De Sterilib. n, 13.
{6) Loco ir.odo cit.
Vol. II. 4 P - Then
658 Book III. Of Difeafes of the Belly.
Then opening the fundus uteri, and the upper part of the neighbouring
cervix, I obferv'd the furface of the former to be of a bright red colour •,
but the furface of the latter not to be fo much as inclin'd to rednefs.
In the fundus, whether you look'd upon its anterior, or pofterior parts,
were very low excrelcences, of no inconfiderable circumference however •,
being imooth, and f.arcely funk lower than the furface-, which were of a
red colour, and more inclining to brown than the reft of the furface.
Moreover, in order to examine the remaining part of the cervix, before I
cut into it, I pais'd a thin probe from the fundus uteri towards the orifice;
but found that the paffage to this orifice was not open.
"Wherefore cutting into the vagina, and bringing this orifice to view, I a
deavour'd to pals up a probe from the lower opening, but in vain ; where
upon I txamin'd the part with attention, and law that the orifice, and its
prominent corona, were in a natural (late, except that, at a little fpace be
low the orifice, it fhow'd fome fmall corrugation as it were.
The orifice itfelf was very narrow, and quite in the form of a circle. When
I examin'dit internally ; at a very little diltance from thence, a fmall whitifh
membrane came to view, which perhaps ttreighten'd the paffage, -but cer-
tainly fhut it up : and this made an obstruction to the probe, either in paf-
fing upwards, or downwards.
Nor indeed was this to be reckon'd among the valves which I have deli-
neated (e)y in a former work, in the cervix of the virgin uterus •, for none of
thefe (hut up the paffage of the cervix except in part, and are all of them fo
iituated, as to refill the afcending probe indeed, but to give way to the de-
fending.
Yet 1 will not deny but this little membrane, which I juft now defcrib'd,
might be perforated with fome fmall foramen, as Littre (f) faw in his ; or
had at lean; left a very fmall interval in fome part of its circumference,
betwixt itfelf and the parietes of the cervix ; fince I found no fluid collected
in the uterus: unlefs we fuppofe it to be a membrane not of long {landing,
and that the fluid might have been taken up by the abforbent veffels.
1 8. And I fhould rather fuppofe, that Nabothus (g) had refer'd to fome-
thing of this kind, or a fomewhat more interior appearance, when he laid, " that
" an extraordinary narrownefs of the internal orifice, of the uterus, could no
" more be known" in the living body, " than a folitary difeas'd conforma-
" tion of the ovula." For this learned man could not be ignorant, that it
had been more than once afferted, to this effect, by Hippocrates (b) : if the
" os uteri is fhut up ; it becomes thick, as if the woman were pregnant:
" and if you touch it with your finger, you will find it hard and convoluted,
,** nor does it admit the finger;" and that experiene'd furgeons do every day,
by introducing their finger, for examination, reach quite to the os uteri, ef-
pecially when the woman is in a Handing pofture.
And indeed the fame orifice, in a different pofture of the woman •, that,,
for inftance, in which they introduce what is call'd the fpeculum uteri; may
be brought into view, even without that fpeculum, as I have more than
(*) Adverf. Anat. i. tab 3. (b) De Morb. Muliebr. 1. 2. n. 50. & de
(f) Supra ad n. 16. cit. loco. Nat. Muliebr. n. 33.
{<>) N. 20. Difp. fupra ad n. 12. cit.
i once
Letter XLVJ. Article 19, 20. 659
once fcen : efpecially if" the vagina be pretty fliort •, by intr. . for ex-
ample, inftead of" the fpecuUim, an ivory or chryfta] funnel, of a proper
length and breadth ; and a light at the lame time, if it be necefiTary ; in
the manner which was formerly pointedfbut by me, on another occa-
fion (#).
19. The obliquity of the os uteri, alio, may refill: the entrance of the fc
men. And this obliquity of the OS uteri, is the natural conlequence of the
obliquity of the uterus; as Hippocrates (£) has taught us, by laying, "if
" the uterus becomes oblique, the os uteri becomes oblique alio." But as I
am to treat of the oblique uterus in another letter (/j, I go on, at pre*
fent, to fubjoin my oblervation, of" the very fmall uterus, which I have pro-
mis'd you.
20. A little woman ; of about fixty-fix years of age, of a ftatuie much
below the middle lize, yet much larger than to be clals'd with the fpecics of
dwarfs ; who, having been for many years the wife of a porter, that was now
dead, a robuft man, but weak in his mental abilities; had never born any
children; laft of all, before the middle of December 1749, came into the
hofpital in a very weak (late, but complaining of nothing befides hunger (for
fhe was a beggar) and of the injuries of the cold feafon. While fiie lay in the
hofpital therefore, to repair her ftrength, behold fhe was feiz'd with a iudden
deliquium animi, and within an hour was carried off.
On opening the belly, they immediately found the caufe-of her fud-
den death, that is, an ablcefs ruptur'd in the meientcry ; whereby a great
quantity of ftinking matter was difcharg'd into the cavity of the belly :
which circumftance brought on the fatal event, in this old woman, fo much
the fooner, than in the carman defcrib'd by the illuftrious Heifter (;»), as her
ftrength was fo much the more pull'd down, as I fuppofe, and her time of
life fo much the more advane'd.
And when this matter was exhaufted, and wip'd away, and the mefentery,
together with theinteftines,remov'd, they immediately went on to takeout the
urinary, and genital, parts from their fituation, agreeably to my orders ; as
both of them were to be demonftrated there, to the ftudents in anatomy, in
the fame manner that I had, the day before, demonltrated thefe urinary and
genital parts from a male.
And this I did, not to fhow them the natural ftate of the parts, as at other
times ; but that they might fee their preternatural ftate, when it fo happen'd,
and in part the more rare conftitution thereof.
And in the kidnies indeed, there was fuch a diforder, as to fhow thofe ve-
ficles full of ferum, partly prominent on the furface, and partly half-buried
in the fubftance ; elpecially the right, which had a large one at its lower
extremity, and the furface befides, if you look'd upon it attentively, un-
equal.
Yet the ureters were not dilated, but even open'd by very fmall orifices in
the bladder, which was found ; except that, notwithstanding the reft of the
coats were contracted into themfelves, the external was, neverthelefs, not
(*') Epift. 14. n. 13. (/) Epid. 42. n. 31. & feq.
(*) Libro novifiime cit. n. 34. (/») Difi". de Hern. Carnof. §. 28.
4 P 2 only
660 Book III. Of Difeafes of the Belly.
only very lax, bur even eafily ieparable from the other: fo as to follow the
hand upon being (lightly drawn.
Finally, if you look'd upon the internal furface of the urethra, which was-
of a proper length, you might fee fome very fmall veficles here and
there.
But, in the genitals were a great number of deviations, from the ufuar
order of nature. For to fay nothing of the fmallnefs of the pudendum in a
woman of that age, and the wife of a porter, and the very remarkable dimi-
nutive ftate of the nymphae, fo that only the beginning of them, and that
very fhort, and flight, appear'd •, the glans and praeputium clitoridis were no-
where at all to be met with : but in the place of both thele parts, was a
round and but little prominent tubercle, cover'd over with the fame fkin as
the pudendum itfelf.
Upon cutting into this tubercle, I found a quantity of matter, entirely of
the fame nature with that which is collected under the praeputium of the clito-
ris, and of the penis •, being whitifh, and half-dried, and, for that reafon,
<3ifpos'd into pellicles, as it were, which lay one upon another, as it gene-
rally does in a dried ftate : and under almoft the lower part of that matter,
I found the glans clitoridis, and its praeputium •, both of them (lender and
fmall •, fo that the much greater part of this protuberance was made up of
that matter.
And thefe things I have here defcrib'd the more at large, becaufe, by this
obfervation, a certain doubt (which Santorini (n) had weaken'd) of Boer-
haave's (0), who was in other refpects a very great man, is remov'd.
For certainly, as the fkin, when cut into by me, fhow'd neither any fign
of a foramen, nor had the leaft trace of any cicatrix ; the matter could ne-
ver have been collected there, that had come from the fmall canals of the
urethra ; nor yet from the other neighbouring glands •, fo that it is now very
evident this matter muft be deriv'd from the fources which are in the glans,
or praeputium, of women ; and confequently, of men alio.
However, neither the body of the clitoris, nor the crura, nor any of thofe
mufcles which are generally afcrib'd thereto, were wanting : but the plexus
retiformis was of a very (lender thicknefs.
And although but juft a (light trace or two of the hymen remain'd, yet
the orifice of the vagina was fo narrow in its dtmenfion, that it feem'd never
to have admitted a man : it certainly did not equal the dimenfions of my
middle finger in any direction, nor would have admitted it.
The breadth of the vagina, when open'd longitudinally, and difplay'd, was
fcarcely more than two fingers breadths, at the fame time that the length was
not equal to four. There were no caruncles within, no rugae; if you ex-
cepted a very fhort and narrow corrugation, as it were, behind the other fida
of the orifice of the vagina.
The os uteri was furrounded with no protuberating corona, and was al-
moft of the form of a circle ; but fo fmall as not to admit the head of a
little probe.
(«) Oof Anat. c. 10. $. 12. (0) Epift. de Fabr. Glaid.
1 From.
Letter XL VI. Article 2r. 66 1
From thence, ro the upper and outer p;irt of the fundus uteri, there was
not ib much diftancc as to be equal co the Largeit breadth of my thumb.
Nor was the U| ptr pait, that is the widcll part, of tlic uterus, wider than the
length 1 have mention'd ; for the other part did not equal even the width
of the point or my little finger} even il look'd upon before it was cut into.
In cutting into it, 1 found the thicknefs of the parictes, both of the fun-
dus, and ot the cervix, to be tonliderably left than in that figure of de
Graaf, where (p) he reprelents the uterus of an infant, who died on tbe
twenty-third day after 11 tc was born ; and where they are represented, to be
extremely thin.
Ftom this figure, when compar'd, in length, with that which I refer'd to
julr. now, you will ealily conceive, that the uterus of this woman, of whom
I fpeak, does not feera to have increas'd finee the time of her birth •, or if
it grew in length in its upper part, at lead that it had grown far lefs, in
proportion, than the other parts of the body, though in a little woman -,
anu certainly, that it had never dilchargM any menftrual blood.
However, as you fee in that figure, loin this woman alfo, the cavity of the
cervix was twice the length of the fundus uteri •, but in the cavity of the cer-
vix fome fiores only could be very oblcurely feen, and thele in a longitudinal
direction : and the internal furface of this cavity was white ; whereas that of
the Hindus was of a redift] colour inclining to brown.
Nevertheless, the Falloppian tubes were much longer than fuch a fmallnefs
of the uterus feem'd to promife ; and the orifice betwixt the fimbrias was
©pen : although I found the fimbriae of one of them externally rough with
whitifh, and roundifh bony bodies, or at kaft fuch as were very hard in their
confidence.
In the alae refpertilionum was no plexus ; yet many nerves ran upon them
in the longitudinal direction. The round ligaments of this uterus were very
(lender. But the broad ligaments were very large : which was the conie-
quence of the uterus being ib very contracted in its breadth.
I look'd upon the upper edges of thefe ligaments, to fee what kind of
teftes this woman had been furnifh'd with ; but look'd to no purpofe. Then
purfuing the fpermatic veneris with great accuracy, which feem'd to be not
much fmaller in this body than ufual ; particularly where they went to the
broad ligaments of the uterus, with the neighbouring portion of the perito-
naeum (from whence thefe ligaments begin) which was (till annex'd to them j
I very clearly perceiv'd that fhe had never had any tefles, nor even the mod
obfeure beginning of them..
21. From thefe appearances, which I demonftrated in a very crowded
circle of ftudents, you mud, in my opinion, be abundantly convine'd, that
it was juft the lame thing to this woman, to be furnifh'd with fuch a very
fmall uterus, as if fhe had been entirely without. And how rare this fmall-
nefs defcrib'd by me is, you yourfelf will be able to judge, from all the ex-
amples of a fmall uterus that are collected together in the Sepulchretum.
Amatus indeed fays (q)y " that a uterus of this kind," that is to fay, a
(/>) De Mulier. Organ, tab. 24. fig. 4. con- (q) In additam. ad feci, hanc 34, obf. 2.
tia litteram G finiftram.
can-
662 Book III. Of Difeafes of the Belly.
contracted and fmall uterus-, " is every now and then feen in fome women v
" particularly in barren women, and thofe that have born no children : and
" in thefe women the breafts are alfo fmall and contracted, fo that from
" them even the fmallnefs, and contracted ftate, of the uterus may be ar-
." gued."
And indeed I have known fome barren women, who had fcarcely any ap-
pearance of breafts •, or indeed none at all, befides the nipple and th*e areola.
But what kind of uterus is it that Amatus refers to ? Why one that he had
feen " betwixt the inteftmum rectum, and the bladder, in a contracted ftate,
" fo as to be taken, by unfkiliul obfervers, for another bladder."
But can you fuppofe that any perfon whatever, even the mod unfkilful,
could have taken that which I faw for a fecond bladder •, fo very ihort and
narrow as it was, and almoft of no thicknefs at all ?
And the fame reply may be made, in refpect to the obfervation of Judecius
(r), on another barren woman, which reprefents the uterus as being " con-
" tracted to the fize of a fmall apple." Which obfervation is taken no
notice of in this feet ion, as according to the intent of the lection it certainly
ought.
But it is taken notice of in another (s), wherein the uterus is faid to have
been " very fmall and contracted, like that of a girl of ten or twelve years of
" age-" Which, for this reafon, was nothing in comparifon to the fmallnefs
of that obferv'd by me ; although that, befides, could not be faid to be
comprefs'd by the bag, which took its beginning from thence, and fill'd the
capacity of the belly, even from fix years of age.
Finally, two obfervations are defcrib'd from Riolanus (/), which, if you read
them fomewhat attentively, you will find to be one and the fame. Nor in-
deed is there any other difference, except that, in the former editions of the
Anthropographia (u), from whence the firft obfervation is copied, the name
of the matron is mention'd •, and in the later editions, from whence the fe-
cond is taken, is omitted-, for as to the number of the chapter correfpond-
ing in neither place, probably this may be owing to the careleflhefs of the
printers : but the tubercle, which is taken notice of in the cervix, and is con-
fider'd, in the Sepulchretum (v), as the caufe of barrennefs, Riolanus feems, if
you attend to what he has premis'd, to have confider'd as the caufe of fecun-
dity ; efpecially as this -natron had not been barren, but had even brought
forth three children.
But be thefe things as they will -, what concerns our prefent fubject is,
that, although " fhe died at the age of fifty-five, fhe had her uterus very
" fmall, very hard, and almoft cartilaginous.
You fee however, that the degree of fmallnefs remains undetermined by the
author-, and although this might have been very confiderable, yet it had
not been fo from the birth, as it was in a woman who had brought forth three
times ; but you fee that it was from a difcafe, which, as it had made the uterus
fo hard afterwards by degrees, might alfo have been the caufe of its contraction.
(r) Qua; i. eft in adchtam. ad fe&.
(s) Sett, hac 34. obf. 4 §. 17.
(/) Ibid. §. 3. & S.
10. I. 2. (u) Utin ilia a. 1626. 1. 2. c. 34.
(*■) Ut in ilia a. 1649. eod. c.
(y) Vid. inter tituios obf. 4. poft n. 4.
And
Letter XLVI. Article 22, 23, 24. 663
And I would have you call this to mind, when you light on other obser-
vations of this kind, and particularly Oil one in which (s) you will read, that
the uterus of a woman, who had been carried oil by a long-continu'd en-
cyfled dropfy "did not exceed the magnitude of a nutmeg; yet was in-
M durated like a cartilage." And another obfervation {a), wherein they
found the uterus " fmall like a pidg( ;g," you wdl have opportunity of
explaining in the next letter (/■■).
22. But in my observation there was, moreover, this extraordinary cir-
cumltance, that the telles were wanting: which were not wanting even in
both of thole women, in whom we have laid that there was no uterus at all
(c ) ; but only in the full. \\\y\ if I were determined to give you a particular
account, in this letter, of all the difcas'd appearances that I have fecn in the
teftes, and the tubes, by dilleciion ; this letter would grow out to a more
enormous fize than any other.
But without doubt I mould be only giving myfelf necdlcfs trouble, fince I
have either given accounts of them in letters already part, or fhall here-
after give them. I will therefore hint at fome things here, which otherwife I
fhould not find a proper occafion to introduce ; firft of the tubes and then of
the teftes.
23. In difiecting the genitals of a woman, about fifty years of age, and
demonstrating them in the hoi' ital, in the beginning of April in the year
1743 •, I obierv'd the following Jiings.
The corona of the os uteri, which was very thick, had, moreover, a
roundifh prominence from one part •, which, on cutting into it, I found to
be white internally, and, to appearance, fcirrhous. And neither of the
tubes admitted a very thin probe, which was already introduced through the
larger orifice to fome exienc, beyond that place : and, in fact, I found both
of them to be quite impervious.
24. I difTected the brain, and genital parts, of another woman, who had
been taken off by an acute difeafe of the thorax, fucceeding to a chronic,
before fhe was forty years of age ; but the brain it is not our bufinefs to fpeak
of here : as to the parts of generation; which I demonflrated in the fame
place and the fame year, and about the middle of December; I found fome
appearances in them, that well deferve to be related here.
To begin with the pudendum, in which the hymen, being uninjur'd,
fhow'd this woman to have been a virgin ; the redifh horns of the femilunar,
and, in other refpecls white; hymen, terminated in a kind of redifh ring ;
with which the tumid extremity of the urethra was furrounded.
And the other orifice of the urethra, which opens towards the bladder, and
the internal furface of the urethra that was nearefl to it, was diftinguifh'd
with parallel, thick, and protuberant lines drawn longitudinally ; which lines
were vefTels diftended with blood.
The vagina, the ofculum, and the cervix uteri itfelf, I found to be in tha;
Hate in which they generally are.
(*) Commerc. Litter, a. 173 1. Spec. 19. {h) N. 26.
to. 2. (<) Supra, n. 13.
(*) Eph. n. c. cent. 1. & 2.obf. 105.
But
664- Book IH. Of Difeafes of the Belly.
But the fundus uteri protuberated fomewhat more than it generally does-,
•nor could I find the caufe of this protuberance in the parietes, which were in
t natural (fate: but I found it to be in the cavity, upon the furface of which
three excrefcences were form'd.
The largeft of thefe was fomewhat lefs, in its circumference, than the nail
of a man's thumb; not very thick, and loofe on every fde: unlefs where it
was join'd, by no very flender peduncle, with the upper fide of the left part
of the cavity : internally and externally it was in great part fo full of blood
as to be quite black : and it was fomewhat lefs hard than the fubftance of
the parietes of the uterus.
At the upper part of the oppofite fide was an equal blacknefs likewife -t
but no excrelcence in that part.
The fecond excrefcence was at a little diftance below that place, being
fomewhat round in its figure, rather fmall in its fize, and nearly of the fame
nature with the firft.
The third which was very fmall, was fituated a little below the firft-, and,
when prick'd with the point of the knife, difcharg'd a water, as if it con-
tain'd an hydatid within its outer (hell -, which was of a black colour inclin-
ing to that of blood.
Having examin'd thefe parts fufficiently, and turn'd my eyes to the ala:
veipertilionum ; in each of them, betwixt the teftis itfelf and the tube, I
obferv'd three or four globules of a larger or lefier fize ; hard in their con-
fidence, and of a red colour inclining to brown ; fo that at firft fight, I fup-
pos'd them to be fcirrhous conglobated glands.
But, upon applying the fcalpel, under the membranous cortex, which was
of the colour I have mention'd, I found a nucleus of a white colour, fmooth,
and eafily falling out-, fo hard that you would have doubted whether it was
of a bony, or a ftony nature : and in its figure and magnitude, if you con-
lider'd it when taken out of the larger globule, it refembled a middle-fiz'd
pea.
The lefier globules each contain'd a nucleus fimilar to this, but lefs in its
fize ; except that, in one of the fmalleft, inftead of a nucleus, was a white
but foftifh matter : fo that you would naturally have fuppos'd the hard nu-
clei to have been form'd by the concretion of this matter.
You plainly fee what impediment there muft have been to the motion of
the tubes, and their nearer approach to the teftes, by the weight and inter-
pofition of this kind of globules. But the teftes moreover were dry, con-
tracted, and ftrigofe. And the tubes were impervious, in the fame manner
as I have related of the former woman -, except that they, neverthelefs, ad-
mitted a very thin probe fomewhat nearer to the uterus.
25. Although I have, in fact, fometimes found the fame kind of occlu-
fion in the Falloppian tubes, of other women likewife, as well as in thefe two ;
which you learn from other letters -, yet I at the fame time confefs, that there
have been ftill more, in whom, though I thought them to be fhut up at the
firft trial, I neverthelefs found, by a more accurate examination, that they
were really pervious : and what I had written in the firft of the Adverfaria (d)f
formerly, I have fince confirm'd at different times.
W N. 30.
And
Letter XLVI. Article 26, 27. 665
And that the lame has likewife been obferv'd by others, is provM by the
tellimony of the very experiene'd 1 [oiler (e) •> who lays that " Morgagni,
" in the iirlt of his Adverfaria, juilly argues againft Uuyfch, that the cubes
" are not lo very frequently obltrucled." But as Ruyfcli, in the obierva-
tion (f) which it is furprizing to fin J not added to the Sepulchretum, had
very clearly pFOpos'd two modes of obstruction of thefe tubes ; one of which
is when they are very clolely coalefc'd, ac one extremity, with the teftis, the
fecond when they are obllrufted in a different manner ; it might have been
evident to every one, who read thefe Advcrfaria of mine with attention, that
I had not fpoken at all of the tirtt mode •, as this is fo evident, that it does
not require any ftrict examination, to bring the obstruction to the cleared
view.
And this being the date of the queftion, I confefs, that, when I read what
Ruyfch replied in his own behalf (£); notwithstanding I thought myfelf much
oblig'd, by the very great humanity which that excellent anatomiit exer-
cis'd towards me, I was, nevertheleis, equally furpriz'd that I fhould have
44 feem'd" to him, " never to have feen, in my own anatomical inquiries,"
that coalition of the tube with the teftis.
For I had feen it, and have even feen it fmce, as my letters to you demon-
strate; and not only in old women (b), but in young women alfo (/') : and
fometimes in both of them on both fides (k) ; at other times on one fide only
(I). But I have other obfervations ftill remaining, two of which I will take
the trouble to tranferibe here.
26. An old woman having died from a blow on the head, her genitals,
together with the urinary parts, were brought to me, when I was delivering
my public lectures in the college, about the end of January in the year
1743-
The trunk of the aorta, where it defcended betwixt the kidnies, had its in-
ternal furface very unequal on every fide •, from the upper part quite to the
termination ; and in a manner corroded, by reafon of bony fcales, which were
fo thickly ftrown, that the orifices of the lumbar arteries could not be known
without difficulty.
And the tubes of the uterus were fo grown to, and confounded with, the
ttftes-, which in other refpedts were not tumid •, that one of them in particu-
lar, which was intirely without the fimbria, could not at all be diitinguiih'd
from the teftis.
27. About the fame time of the year, but in the year 1746, the genitals
of a woman •, who died, within about the thirtieth day after her delivery, of
a (low fever •, were brought to me to the fame place, in as perfect a ftate as
they could be procur'd.
For the teftis, and tube, on the right fide, were agglutinated to each
other, and to the neighbouring inteftinum colon, and, in part, already de-
ftroy'd by an abfeefs ; which I fuppole to have been the principal caufe of
her fever and death.
(e) Hift. Diffect. Foem. gravid. §. 2. not.t>, & (b) Epift. 12. n. 2.
ad Prasleft. Boerhaav. ad Inftit. §. 668 not. e. (i) Epift. 38 n. 34.
(f) Cent. Obf. Anat. Chir. 83. {i) Ibid. & Epift 21. n. 47.
(g) Adverf. Anat. dec. 1. c. 2. (I) Epift. 29. n. 14. & Epift. 26. n. 13.
Vol. II. 4 Q^ The
666 Book III. Of Difeafes of the Belly.
The ftate of the uterus, fuch as was to be expected in a woman who had
lately born a child, I mall defcribe in another place : it will be fufficient to
remark, in this place, what feem'd to be morbid.
That is to lay, fome part of the corona of the os uteri, looking on it an-
teriorly, was of a violet-colour, inclining to blacknefs : but by cutting into
it alfo, I obferv'd, within the fubftance of its parietes, a blacknefs, as if from
blood ftagnating within the dilated veilels ; from the orifice quite to one half
the extent of the cervix.
Finally, the left teftis did not differ in its colour, and magnitude, from
any found teftis. Yet its fubftance was fofter than ufual, and when cut into
more moid ; fo that it might feem to be made up of a kind of jelly as it were,
rather than of any other fubftance.
There was no where any appearance of the corpora lutea, nor any veficle ;
if you except a fpherical little cell of the bignefs of a fmall grape, empty,
and made up of a thickifti and whitifti coat. Which cell, being fituated un-
der the very membrane of the teftis, had given marks of its exiftence before
the teftis was cut into. For under an obfeure kind of cicatrix, correfpond-
ing to that cell, fomething of a yellowim colour was feen to fhine through.
28. I do not think that you will take an argument from this ftate of both,
the teftes, and one of the tubes, in order to refute the opinion which is now
embrae'd by moft learned men ; or at leaft a great number of them.
For you not only know, how eafily arguments of this kind, which were
formerly inculcated by Nabothus (m), and others alfo, are invalidated ; but
even others which are more difficult to appearance •, as, for inftance, when
they object the cafe of a certain woman ; who having been pregnant only for
fo fhort a time, that the foetus was icarcely equal to the length of a little
finger ; had, neverthelefs, both of her teftes in a fcirrhous ftate.
For it is fufficient, that, when a woman conceives, no leis a part of either
teftis is found, than belongs to one mature veficle, or rather to one mature
corpus luteum. And when this has perform'd its office, if itfelf alfo is vi-
tiated by the extenfion of the difeafe, and degenerates into the nature of a
fcirrhus, as well as the other parts •, it is no objection at all to the opinion in
queftion.
And what forbids us to aflert, that it may be vitiated within a few weeks,
not to fay within thofe nine months of utero-geftation ?
For which reafon it is the more furprizing, that there mould have been any
one, within this little time, who made objections to that opinion, from the
tubes being found, by him, to be without fimbriae, and the orifice, that is
between thefe fimbriae, to be quite {hut up, in a woman who had born a
child eight years before : as if it were neceflary to believe, that the child was
born while the woman was in this ftate •, and not that Ihe had rather been in-
jur'd, in thofe parts, by a difeafe which was not of long (landing : efpecially
as " a certain pyriform bulb, turgid with whitifti and fluid matter," which it
is moft probable was pus, occupied the place of the fimbrise.
But " fictions help the understanding," fays he, M though they do not de-
mon Urate the truth of the matter."
Cm) Difput. de Sterilit. Mulier. n. 1 1. & \z.
Yet
Letter XLVI. Article 29, 30. 667
Yet where there is no room for demonftrations, and the opinion, which is
attack'd by arguments of" that kind, is already very will fupportcd by rea-
lbns, and obfervations •, we muft fee what is the molt probable, and agrees
the beft with thefe realbns and arguments, in order to reply to the objections.
And that you may perceive, how differently the thing appears to me from
what it does to him ; he thinks that not even eight years are lufficient to bring
on diforders of this kind.: but to me it feems that even the very time of a
difficult birth is fometimes lufficient •, provided the time of lying-in is not
very happy afterwards.
For, in fuch a birth, the vehement and frequent (trainings urge the gravid
uterus (as I have already (n) hinted) againft the teltes, and the fubjected
tubes ; which parts are prefs'd againit the bones of the pelvis, and contract
the beginning of an inflammation, which is foon after increas'd by the lochia,
for inftance, when they flow but very fparingly.
And I fuppofe thefe things to happen fo much the more eafily, in pro-
portion as violent and frequent vomitings, during the courfe of the foregoing
utero-geftation, have prefs'd upon, and fhaken thefe parts ; or fome other
caufes have begun to injure them, and difpos'd them to contract the difeafe.
But omitting thefe things, let us return to the hiftories ; and as I have
hinted at fome things, in regard to the peculiar diforders of the tubes, and in
regard to thole which are common to the tubes and the teltes ; let us now
alfo fay fome things briefly, in refpect to the peculiar diforders of the teftes.
29. A woman, of about forty years of age, had been formerly attack'd
with an apoplexy i which returning, at length carried her off. I was at this
time giving the public demonftrations of anatomy, in the year 1725 : but no
other parts were brought into the college, befide thofe which are fubfervient
to the offices of generation, and the fecretion of urine.
The trunk of the great artery, where it lay betwixt the kidnies, fliow'd,
internally, fome very flight beginnings of bony fcalcs. The kidnies them-
felves, which were not furnifh'd with a very great quantity of fat on their
external furface, were neverthelefs ltuff'd up therewith, to fuch a degree,
betwixt the papillse, that I never remember to have feen more.
Both the teftes were contracted and lank •, but the right by far the moft
fo : and from thence an hydatid was prominent of the figure and magnitude
of a chefnut, containing a brownifh water within* thicken'd coats ; which
were, on their internal furface, fmooth and equal.
In the left teftis a round cell was quite buried, not larger than a very fmall
grape •, being made up of white and thickifh parietes, that were internally
unequal, and contain'd a fmall quantity of humour.
However, in neither of them was there any of the natural veficles.
30. As thefe veficles are neceffary to generation, whether they, as moft per-
fons believ'd, are eggs, or rather are chang'd into the corpus luteum •, it is
juft the fame thing, you fee, whether they are perfectly wanting, or do not
contain that fluid which they ought to contain.
Wherefore, it is not to be wonder'd at, if a woman •, who was in other re:
fpects healthy, and young ; and married to a young man of a robult conftitu-
(») Epift. 39. ir 38.
4 Q^2 tion 5
668 Book HI. Of Difeafcs of the Belly.
tion ; in whom VaHifneri (o) found all the veficles full of a turbid, and fuli-
ginous matter, which had but little fluidity, was barren.
And there was great reafon to fear, that another young woman •, who died
within an hour after her firft delivery, in both of whofe teftes Alexander Bonis
wrote to me that he had feen, with Santorini, a great number of veficles of
various magnitudes, containing a pellucid humour indeed, but in which a
fmall white corpufcle was feen, which veficle foever you examin'd ; there was,
I fay, great reafon to fear, left this woman would have been barren, if fhe had
liv'd.
And this obfervation of my mod refpe&able friends, I have the more rea-
dily taken notice of to you ; that you may perceive this to be the effect of
difeafe, which fome authors of note have confider'd as a proof of the veficle
being become fecundated.
31. How many obfervations of my own, of diforders in the teftes of wo-
men, I might add to thefe befides j if I were not cautious of being too pro-
lix •, you will conjecture even from thofe things which I have formerly
thrown out in the firft of the Adverfaria (p), in regard to the diforders of
thole parts ; fome of which I had found very rarely, and others very fre-
quently.
And as many, in confirming the fame things, have taken notice of this
pafiage ; fo I do not know why but very few (among whom in particular was
the celebrated Paitoni (q) ) have mown that they had read the other pafiage,
where, in- the fourth Adverfaria (r), I have faid what I thought of the nature
of thefe veficulas, and the corpora iutea, and their ufe, together with my rea-
fons for my opinions; whereas many authors, neverthelefs, fince the year
1 719, in which thofe things were publifh'd, muft have repeated the fame
things in their writings.
But to return to the firft pafiage -, they who have abus'd thofe obfervations
of mine, or fimilar ones of other authors, fo as to contend either that the
teftes are ufelefs, or that women would for the mod part be barren ; either
have not obferv'd, that thefe diforders are not generally met with in the dif-
fe&ion of young and found women, or that it is not neceflary for conception,
that every part of both teftes fhould be found •, nor finally although befides
the teftes, there are fo many other parts in women, which are themfelves
liable to difeafes, and yet are necefifary for the procreation of children, that it
neverthelefs does not happen very feldom, nor yet for the mod part, nor yet
from the fame caufe, that women either are actually barren, or become fo;
and that Hippocrates (s) had. formerly faid with great propriety : " and fo
many and various kinds of diforders happen to women, on account of which
" they do not bring forth, before they are cur'd of them,, and many by which
lt they become quite barren ; that women need not be furpriz'd they do not
14 bear children, though they have frequent commerce with man." Farewell.
(c) Id. della Generaz. p. 2. c. 5. n. 14. ft J Animad. 28.
(p) N. 30. (s) De Sterilibus n. 5.
ty) Delia Generaz. dell' Uomo Difc; 3*
LETTER
Letter XLVIL Article I. 669
LETTER the FORTY-SEVENTH
Treats of Diforders in the menftrual Flux, and of the
Fluor Muliebris.
ALTHOUGH Bonetus has given a particular fection to each of thefe
fubjecls •, that is the thirty-fifth, and thirty-fixth j yet I have more
than one reaibn for comprifing both thefe fubjecls in a fingle letter.
For in the firlt place, I have obferv'd this circumftance, that if you take
away the long and frequent fcholia; and thofe frequently fuch as are quite
ufelefs, fince more confident doctrines have been taught in the medical
fchools •, you will find that not many obfervations remain in thofe otherwife
fhort fections.
In the fecond place, I have obferv'd that there are fome of thefe, as Bone-
tus himfelf confeifes, which have been propos'd by him in other places ; and
even that there are fome, which are repeated in one and the fame fection,
without his being aware of it ; as, for inftance, in the thirty-fifth, the fourth
obfervation is repeated, in the laft article under the feventh obfervation, that
is in article the tenth ; and in the thirty-fixth fection, you will find what is
read under the firft. article of the firft obfervation, repeated under the fecond
article.
And thefe repetitions are fo much the lefs tolerable, becaufe either the
hiftory is imp^ rfect in the fecond place, as in the fecond example ; or even
in both places, as in the firft. Nor would I have you fay that the readers
are, in both cafes, refer'd to the fection intitled de ventris turner e, book the
third. For we muft turn over a hundred and eighty-fix large pages, in order to
light on that hiftory at length •, which begins in far different words, and is for
that reafon lefs eafy to be found, under the fifty-fifth obfervation, in article
the twenty-third : but even there it is not accurately copied, nor amended by
any needful animadverfions.
For the author of the hiftory, I mean Dodonasus, in that very thirty-fourth
chapter which is refer'd to, had faid, that no excrementitious matter had been
difcharg'd from the uterus of this virgin, through the whole of the difeafc,
notwithstanding the uterus was ulcerated ; and that becaufe " the hymen,
*■' which nature has granted to virgins, prevented the difcharge."
But in the Sepulchretum, inftead of quod natura virginibus concefu, we read
5. ' ff*
670 Book III. Of Difeafes of the Belly.
qui natura virginibus concrefcit. That is, if it convey any idea at all, which
naturally grows together in " virgins."
Yet read it which way you will, how do the menfes flow out in other vir-
gins ? And even in this very woman who was *' fifty-five or fifty-fix years of
" age," if they had not flovv'd out before the difeafe ; how could Dodonseus
have omitted that circumftance ?
Wherefore neither quod natura concejfit nor qui natura concrefcit can be ad-
mitted of.
Laft of all, I wonder that fome obfervations, together with their fcholia ;
as that for inftance which we have in the thirty-fifth feftion under obfervation
the firft ; do not, as the intention of the feftion requir'd, relate to the caufes
of difeafes; but to the natural fources of the menftruous blood: and that
thefe, if you attend to the obfervations produc'd, are determin'd to be in the
vagina : which indeed I have never denied ; although it has never yet hap-
pen'd to me, to fee them elfewhere than in the fundus uteri : nor can
I lay any great ftrefs upon fome reafons they make ufe of to confirm this
circumftance •, as that, for example, which is fubjoin'd in the fcholium to
article the fecond of the firft obfervation ; I mean that " fometimes cancers
" or fchirri of the vagina come on : and that fo much the more if the men-
'•' ftrua are deficient ; becaufe the blood which was wont to be purg'd off", is
" delay'd there for a very long time, ftagnates and becomes of a hot nature :
" whereas thofe malignant ulcers and tumours more rarely are form'd in the
" fundus and cavity of the uterus itfelf."
For whether this, to take no notice of other things, does happen ' ' more
" rarely," the greater part of the obfervations in the next fection will mow
you.
But let us omit the confideration of thefe things, and of the third obferva-
tion which relates to the natural caufe of the menftrual purgation; with" the
very prolix fcholia that are the confequence of it; and bearing in mind the
intention of this letter, firft, in regard to the menftrua, let us copy from the
obfervations of Valfalva, thole things which relate to the morbid ftate
thereof.
2. A virgin who feem'd of a falacious difpofition, or was at leaft very
lively, had never yet had any menftrual difcharges, when fiie died in the
nineteenth year of her age. The uterus was very fmali : yet the length of
the fundus was not lefs than that of the cervix.
3. This is fuflicientto mow you, that the uterus had nevertheiefs increas'd
more in this virgin, than in that woman whom I defcrib'd in the former letter
(a) ; notwithftanding it was very fmall indeed, and fmall for that age : and
this obfervation will confirm the conjeclure I made in regard to the former
woman, that fhe had never been menftrually purg'd.
For it may excite a fufpicion in us, whether the appearance of the men-
ftrua, in fome virgins, who are in other refpects healthy, full of alacrity,
and have attain'd to a proper proportion or body ; when it happens fome
vears later than it does in general ; whether, I fay, this appearance fhould
i t be alcrib'd, fometimes, to the very flow increale of the uterus.
For I knew a noble virgin ; that is to be number'd in the clafs of thofe of
(«) N. 20.
whom
Letter XLVII. Article 4, 5. 671
whom I have been (peaking j who, being married before her menfes, which
had been expected tor lbme years, appear'd, was neverthelefs very fruitful :
and that we may the lefs be furpriz'd thereat, the very fame thing had like-
wife happen'd to her mother.
And without doubt, it is much better, where the young women arc in
good health, to wait and do nothing; as I did in that cafe; left by our in-
opportune remedies, we perhaps caufe a delay in the work of nature, which
flie performs later in lbme than in others.
4. Another virgin, who had now been without any menftrual purgation
for many years, and had been long troubled with ulcers in the tibia, died in
a tabid date.
In the thorax, and belly, was a ftagnant water. The teftes were without any
veficles, and confided of a fubftance of a whitifh colour; which bore a re-
lemblance to the pancreas, but was of a fofter nature. On the internal fur-
face of the uterus were a great number of glandular bodies protuberant ; ex-
cept that in the upper part of the fundus there were but few obferv'd.
5. This, you fee, is another example, that may be objected to fome phy-
ficians, who are too bufy in bringing on an appearance of the menfes. For
they do not confider how various, and different from one another, the caufes
of their not flowing may be; and immediately have recourfe to fuch things
as excite them : as if the uterus itfelf were always fufflciently prepar'd to
tranfmit the flux which- they provoke.
Therefore they frequently increafe the caufe of the diforder, inftead of re-
moving it.
Thefe remedies fucceed very well, in mod of thofe perfons where the blood
is vikid, or inert from too great a quantity of ferum ; as I have, for the molt
part, ken this to abound in blood that has been taken away by venaefection ;
the remaining part being generally contracted into a cylinder, of a more
(lender fhape and confidence than ufual ; when this purgation was wanting .
either wholly, or in great part : and indeed I have obferv'd the fame, even in
a certain woman whofe menftruahad been accidentally fupprefs'd, in the mid-
dle of their courfe, by a fright ; though this had happen'd only five or fix
days before.
But how can thefe remedies have a good effect, not only when the blood
is, on the contrary, of a more hot difpolition, or in greater plenty in the con-
ftitution ; but when the blood itfelf is in a proper quantity and date, and
the uterus is, neverthelefs, very dry, and contracted ; or, which you may
fufpect from certain long-continued diforders, as in the virgin in queflion,
affected with fome organical difeafe ?
Without doubt it is more proper fometimes, to moiften and relax ; and at
other times to refolve difeafes, as far as this can be done.
I knew a phyfician of eminence, who was accudom'd to ufe the filings of
fteel, mix'd into a pillular mafs with aloes, ammoniacum, and the concreted
juice of fuccory ; adding moreover, when he thought the force of the medi-
cine needed to be increas'd, a little dittany of crete, myrrh, and fafiton : and
of the pills made of this mafs, he, in general, gave two before a fparing
fupper ; but in the morning he gave broth, medicated with herbs, and roots,
that might have the power of foftening and opening : and by thefe remedies
he
672 Book III. Of Difeafes of the Belly.
he faid he always faw the wifh'd-for effect ; provided a proper regimen or
living was obferv'd at the fame time.
There is no doubt but this phyfician •, whofe remedies I have taken notice
of, not becaufe they are not in the number of the mod common, but becaufe
fome are endow'd with different virtues from thofe of others •, might often
bring about what he had undertaken ; yet he would better have effected his
intention, if it had been in his power to know, what it was neceffary to do
in the cafes of particular women.
For one remedy alone, if more fuitable than the others, has the defir'd
effect fooner, and more to the purpofe.
Thus I likewife know another phyfician, who, when he fees that there is
room for aloetics, gives every day nothing more than a few grains of aloes,
wrap'd up in any thing that can obtund the fenfation of bitternefs ; and fays
that with thefe alone he more fuccefsfully recalls the menfes, than by giving
many more grains, or other remedies at the fame time with them.
And in regard to a proper method of living, which, as I have faid, is not
to be neglected ; this is fo much the more certain, as it is more evident, that
the menftrual purgation is very much diminifh'd, and fome times fupprefc'd,
by errors in the diet, exercife, and the like.
Thus, to illuftrate the modern errors of fome women, by an ancient ex-
ample •, Galen (b) has deliver'd down in his writings that, at Rome in his
time, " it had happen'd that, as women in common drank the coldeft water
" from diffolv'd lhow, they either had no menftrual purgations at all, or at
M leaft had them only in a fmall degree."
6. But to return to thofe remedies which excite the menfes ; it fometimes
happens .that there is no room for them, either at prefent, or in future; as,
for inftance, when the uterus is affected with a diforder of fuch a kind, that
it cannot be remov'd.
Let us take an example of this kind from the very experiene'd Bene-
voli (f).
He difcharg'd, in four virgins, by means of chirurgical remedies, the
menftrual blood which had been retainM in the cavity of the uterus. The
three firft of them had blood difcharg'd from the uterus, every month after-
wards, according to the ordinary courfe of nature.
But the fourth had no difcharge of the kind, even eight or ten years after ;
all the endeavours of phyficians to procure them being in vain. Why fo ?
Without doubt becaufe this laft had not had the blood confin'd, for only a
fliort fpace of time as the others had, but for the whole fpace of three years ;
fo as to be now increas'd to the quantity of two and thirty pounds, and to
have much purulent matter mix'd with it.
It was probable therefore that the internal furface of the cavity of the
uterus-, being injur'd, and cover'd over with a cicatrix-, had no longer the
orifices open, by which the blood is, at ftated times, difcharg'd.
What, then, can we expect, in this, or any other fimilar cafe, from fuch
remedies as provoke thefe difcharges, but to add diforder to diforder? Let
.(/J) L. dc venae fe£. adverf. Erafiftratseos c. 3. (c) OiTervaz. 1.
fucli
Letter XLVII. Article 7, 8. 673
Inch women as thefe ufe I (paring diet, and lofe blood, by venje-fection in
the arm, when there is occafion.
7. But now, as I have enter'd into a difcourfe, which I know to be very
plealing to you, relating to the methods of Curing, by medicine, fuppref-
lions, or obitructions, of the menftrual blood •, before I go on the anatomical
hittories of the contrary dilorder, I will take the trouble to fubjoin the me-
thod to which that induftrious, and experiene'd man, Zanichelli, trufted
greatly in counteracting this fecond difeafe.
He order'd fnails, of that fmall and whitifh kind, which are found upon
the carduus ftellatus, to be bruis'd in a mortar, together with their fhc lis ;
adding a little quantity of the conlerve of violets as it is call'd ; after which
they were hung up in a linen cloth, and the defcending liquor receiv'd even
by the help of compreilion.
Of this liquor, when frefh-made, he ordered three ounces to be drunk
every morning; and the fame quantity at noon before dinner-, and in an
evening likewife before fupper •, when he fuppos'd this too great difchargeof
blood, from the uterus, to proceed from that fluid being in a difiblv'd ftate ;
and impregnated with irritating particles.
And he afflrm'd that this liquor had anfwer'd fo well with him •, and had
produe'd fo good effects •, that he had even transferr'd it to the restraining
of bloody difcharges from the chefl, if thefe happen'd from the fame caufes ;
nor would he commit this fecret to me, on any other condition, than upon
promifing that I would reveal it to no perfon, as long as he was living ; and
this I have perform'd.
The following; relation I alfo receiv'd from him : a woman having; labour'd
feven years under an uterine haemorrhage, and all other remedies being in
vain •, fhe was perfectly and happily cur'd by him, by means of giving the
juice of lemons, and an equal weight of fpirit of fait. And he had been in-
due'd to give thefe remedies, becaufe he had conjectur'd that there was a kind
of fcorbutic ftate of blood in this woman ; and becaufe he had before expe-
riene'd how much it had been of advantage to others, to hold this liquor in
their mouths, when it was considerably eroded by the fcurvy.
From thefe cafes then •, which I relate to you, juft as he related them to
me ; it appears that in this difeafe, as well as in others, the conjecture of
caufes is of great importance : nor can the fame remedy be proper for all.
But fometimes there is no room for any remedy, except in the beginning ;
as you will understand from that hiftory, which I fhall here annex, from Val-
falva.
8. A woman, of one and fifty years of age, had begun, five or fix years
before, to be troubled with a considerable profluvium of blood from the ge-
nitals : fo that coagula of blood were difcharg'd which weigh'd half a
pound •, other lefTer coagula following them.
A ferous colluvies was alfo difcharg'd fometimes, and, at others, a humour
like water in which frefh meat had been wafh'd.
If this flux was at any time fupprefs'd, fhe was troubled greatly, above
other fymptoms, with a violent pain, and fenfe of weight in the hypoga-
itrium ; till fhe was reliev'd by the returning flux.
Vol. II. a R To
674 B°°k 1H« Of Difeafes of the Belly.
To thefe diforders was fometimes added a difficulty of makino- water ;
which fluid was at length difcharg'd, after fome confiderable efforts, toge-
ther with a foetid blood, and putrid filaments.
Moreover, the woman was feiz'd, on both fides, with an ifchiadic pain ;
which was fo raging, in the night time in particular, that fhe could fcarcely
get a fhort fleep. Then hyfterical convulfions attacked her with fo much,
violence, that fhe feem'd, more than once, to be at the point of death.
To thefe fucceeded a tumour of the whole belly, with a very great dry-
nefs of the fauces, a frequent eructation of flatus, and an averfion to food
for this reafon ; becaufe even when fhe had taken a little, a tenfion was im-
mediately perceiv'd at the region of the ftomach, which gave her great un-
eafinefs.
Thefe fymptoms, and vomitings, never left the woman even when the other
difagreeable fymptoms were at length appeas'd. And indeed about two
months before her death, the vomiting, which us'd to trouble her but fel-
dom, became frequent ; but in fuch a manner at firft, as to oblige her to
throw up nothing but eggs, which were her ufual food ; the other things,
that fhe took with them, being perfectly retain'd •, and after this fo, that,
for the laft twenty days, fhe fcarcely retain'd any thing of aliment that fhe
took ; let it be what kind foever :_ wherefore her ftrength decreafing every
day, fhe departed this life.
In her carcafe •, which was fo emaciated, that even the mufcles were al-
moft without flefh, as it were ; fcarcely any traces of blood remain'd.
The whole belly was fill'd with a fait ferum, in which fome portions of the
omentum, and a great number of filaments of other kinds, were floating.
The internal furface of the peritonaeum every where fhow'd little bodies,
that bore a confiderable refemblance to the indurated glands of the pan-
creas. The ftomach was fmall and univerfally contracted.
The kidnies, as far as relates to their fubftance, were found. But the right
contain'd very fmall calculi, of different forms •, none of which were in the
left. Both the ureters contain'd urine ; the left a little only : but the right
being dilated to the thicknefs of my little finger, was univerfally full of
urine.
Finally, there was a fordid and foetid ulcer in the collum uteri j though
the uterus was, in the reft of its parts, in a natural ftate.
9. Whether the ulcer was the effect of the profluvium of very acrid blood,
or whether it was the caufe of it, from the very beginning, by corroding
fome of the more confiderable veflels-, the diforders that were afterwards added
to the ulcer, and profluvium, may be eafily accounted for from the nerves
being drawn into confent, by reafon of the fituation of the ulcer ; and from
the blood, by reafon of the great and frequent lofs thereof, being ill repair'd,
and therefore render'd ferous.
For from the one would arife pains, hyfteric convulfions, and vomitings ;
and from the other, or rather from both the caufes when join'd together, an
afcites; the veffels, for inftance, being frequently conftricted by the convul-
fion, and the blood for that reafon flowly circulated through them j and the
ferum, with which the blood abounded, being more eafily effus'd.
But
Letter XLVII. Article 10, u. 675
But the difficulty of making water, and the difcharge thereof not till after
many attempts, we may account for, from the pain in the neighbouring ul-
cerated part, and the ltate of that part •, the retention of urine in the uterus,
and the dilatation of the right in particular, from one of thole ftones which
had been in the kidney of the lame fide, and perhaps a pretty large one,
having fallen into it, and been confin'd there •, and yet, among lb many other
pains, and uneafineffes, not obferv'd when difcharg'd, nor taken notice of
afterwards in the urine, 'which was foul with the fame kind of putrid and
bloody fordes, that cover'd the whole pudendum.
10. If after the oblervations of Valfalva you alfo defire to have mine ;
read over again what I have defcrib'd (d), in the uterus of thole women who
had died with their menflrua either diminifh'd, or flowing in their full vi-
gour. For I will not repeat them here.
But I will rather pais over from the laft propos'd obfervation •, of a proflu-
vium not only of blood, but of a ferous colluvies alio j to the fluor mulie-
bris, which was a fecond fubject of this letter.
To which difeafe although I have no obfervations of Valfalva's peculiarly
relative \ yet there are fo many of mine remaining •, efpecially if I mould
be willing to purfue the beginnings of fome of the caufes of this fluor, ob-
ferv'd by diffection j that I am under a greater danger of exceeding, unlefs I
am cautious, than of not filling up, the bounds which I generally preicribe
to my letters.
11. The fources of the fluor muliebris are, for the moll part, in the ute-
rus. For that which we read in the hiftory of the Royal Academy of Sciences
at Paris (e) ; that from a large abfeefs of one of the ovaria, with which the
tube communicated, a purulent ferum had flow'd down into this tube ; from
thence into the uterus ; and at length from the uterus into the vagina j is
rare.
But the uterus itfelf is the fource, either of a various-colour'd, a fimple,
or a purulent ferum. And the latter flows from the uterus, or the vagina,
when ulcerated.
Yet the former is generally from the uterus, the internal membrane of
which, like that of the noftrils in a coryza, may be affected with a kind of
rheum •, or the mouths of the fmall veffels may fo far contract themfelves*
after having difcharg'd the menftrual blood, as to prevent any farther dif-
charge of this fluid, indeed, but not of the ferum ; in regard to which, as it is
ting'd with a different colour, in different perfons, foit does not make a fluor
of the fame colour in all.
And thefe things I have hinted at in the Adverfaria (J).
Of this rheum of the uterus, eminent phyficians have exprefsly fpoken,
before the more modern -, and among thefe Gulielmus Ballonius (g ), who
call'd it a " catarrh " and Lselius a Fonte (&), who call'd it " a diftillation
*< of the uterus," and faid that it was " a kind of rheumatifm ; and before
them Galen (i) formerly, who has taught us, that thefe fluors are produe'd
*' by rheums of the uterus."
(d) Ep. 19. n. 11. Ep. si. n. 29. Ep. 31. (g) L. I. Confil. Med. 56. fub. fin.
■n. 16. Ep. 38. n. 34. Ep. 45. n. 21. \b) Confult. Med. 117.
(e) A. 1700. obf. anat. 5. (1) De Symptom. Cauf. 1. 3. c. 4.
(f) IV. Animad. 27.
4 R 2 I how-
676 Book III. Of Difeafes of the Belly.
I, however, will firft propofe the obfervations, that are to be refer'd to
thofe which are brought on in the firft, or fecond method ; or a third which
I ihall add (£); and con fi ft of a fimple ferum: and then I fhall give the ob-
fervations that relate to fluors, which have their origin from a purulent
ferum.
12. A virgin about fixteen years of age was brought into the hofpital of
St. Mary de Morte at Bologna, after having been afflicted for fifteen days
with a fever at home. She was no fooner brought in, but (he vomited worms ;
one of which was of a red colour, longer than a fpan, and almoft of the
thicknefs of a common writing quill.
Thefe animals fhe had alfo brought up at home-, the difcharge being pre-
ceded by a gufhing of tears, but not by an itching of the noftrils. She com-
plain'd of a pain, the feat of which fhe pointed out, by applying her hand to
the left hypochondrium, and the neighbourhood thereof; in fuch a manner
that it could not well be afcertain'd, whether fhe meant to mark out her belly
or her breaft.
Pier pulfe was frequent, fmall, and weak. She often flept in the day-
time. In this manner fhe pafs'd three days. At which time, befides the
other fymptoms, the women who were about her, obferv'd that there was a
fluor albus alfo.
On the fourth day fhe feem'd to be frequently delirious. The pulfe was
become weaker, and fmaller. The tongue was red and dry. She complain'd
of a pain in the head.
On the fifth day fhe was very prone to fleep; but on the following night
fhe cried out very much.
On the fixth and feventh day the fame fymptoms continu'd : and fhe then dif-
charg'd her urine, which fhe had always difcharg'd pretty freely, and in a large
quantity, involuntarily, and in a very great quantity.
On the eighth day after her firft coming into the hofpital, being overcome
with fleep, fhe died.
We differed her body on the fecond day after her death ; which day was
the thirtieth of March in the year 1706.
When the cranium was open'd-, for from thence I choofe to begin the
narration of thofe things which we faw •, whatever is contain'd in the menin-
ges was of a very foft nature. Betwixt the pia mater, and the whole bafis
of the medulla oblongata, was a confiderable quantity of water : and within
the ventricles water was alfo found, which was of a reddifh colour.
The plexus choroides were of a pale colour : but the veffels which crept
through the whole pia mater, and thofe alfo that went through the furfaces
of the lateral ventricles, were turgid with blood : and from the fame ven-
tricles, thefe veffels were very eafily pull'd away, together with that mem-
brane-, which was follow'd by a lamella of the white, orcineritious fubftance,
that compos'd their parietes : and this lamella was, in every part, nearly of
an equal thicknefs.
The thorax had both lobes of the lungs, but elpecially the left, adhering
(il Infra, n. 19. & feq.
to
Letter XLVIL Article 12. 677
to the pleura in fome places ; both at t he middle and at the lower part; and
that by means of membranes interposed.
Looking upon the furface of the right lobe, at the upper part, and feeing,
through the inverting membrane, certain globular bodies lying very thick,
and not larger than millet-feeds, I cut into thefe lungs which were in Other
relpecls found •, and found the fame globular bodies lying every where very
thickly indeed, but disjoin'd from each other by intervals •, being hard in
their fubltance, and, to appearance, of a tartareous nature as it were.
In the heart was nothing worthy of remark •, although, in the right auricle,
a polypous cortex of grumous blood cover'd the fide thereof.
In opening the abdomen •, which had appear'd livid, externally, towards
the ilia ; we had feen the liver to be ting'd, at the middle of the lower con-
vex furface, with a fpot of no very large fize, comprehended in the circum-
ference of a circle; being of a cineritious colour inclining to white: which
colour defcended into the lubitance of the vifcus. In the veficlc the bile was
inclin'd to a black colour.
The flat furface of the fpleen was alfo of a livid colour inclining to black-
nefs ; tho' this blacknefs was fcarcely produe'd farther than the coat of it. The
pancreas feem'd to be fomewhat hard. The ftomach, as far as I could judge
externally, was found. We perceiv'd round worms to be harbouring them-
felves in the fmall inteftines, by feeling them with our hands.
Then turning our eyes to the appearances in the pelvis, we obferv'd a fmall
quantity of water there. But upon taking out the bladder (which was dii-
tended.with urine) together with the annexed genitals ; we faw, on the inter-
nal furface of this cavity, the fmall veffels tumid with blood for a confiderable
tract •, lb that beginning above the orifices of the ureters, through which they
were continu'd, they exhibited this appearance quite to the beginning of the
urethra : and indeed betwixt thefe veffels, in fome places, we faw drops of
extravafated blood through the internal coat j and in the urethra itfelf, beneath
the internal membrane, which was fprinkled with its fmall veffels, were
others much larger than thefe, and very much diftended with blood.
The left of the nymphge, which was broader than that on the right fide,
was likewife longer than that, to fuch a degree, as to reach to the fraenum of
the labia •, having a water contain'd within its fubftance.
Moreover, the orifice of the vagina, and the hymen, were of a red colour
degenerating into blacknefs; and fmelt very ftrong : and the neighbouring
part of the vagina, being here and there of a livid colour inclining to yellow,
gave pretty confiderable marks of a gangrene.
Turning from thefe lower parts to the upper, I obferv'd the wider ex-
tremity of the left tube to be drawn downwards by an hydatid ; equal in fize
to a large grape-, which had been form'd in the contiguous part of the ala vef-
pertilionis.
But that a larger hydatid than this, had been pendulous from the mem-
brane of one of the teftes, I perceiv'd from a roundifh corpufcle ; which, a!-
^ though it was corm\..6>H into itfelf, yet even then preferv'd a fmall cavity be-
twixt the rhicken'd coats, and hung from this teftis.
An-' in this teftis were two roundifh bodies buried-, the one bigger than
the other, but both of them made up of a black coat, and of a kind of co-
agulum
678 Book III. Of Difeafcs of the Belly.
3gulum of blood (hut up therein •, which, however, was of a red colour. The
other teftis Hkewife contain'd two unequal cells, form'd of a black coat, bu
empty.
The uterus was fmall, and confifted of parietes of an inconfiderable thick-
nefs. The upper part of its fundus was univerfally red with confpicuous
blood-veflels, on its internal furface. When I had wip'd off the mucus,
which we fee there in a natural ftate, from the ofculum uteri, and the neigh-
bouring part of the cervix •, by comprefiing the inferior part of the fundus,
the cervix, and the corona of the os uteri, I faw a thickifh, and pretty
white, matter proceed from all thefe places •, and that in a regular manner •,
which pretty clearly fhow'd from whence the fluor albus had been difcharg'd.
13. The other parts of this hiftory you will, of yourfelf, refer to the
claries whereto they belong; for I am not willing. to fpeak over again here,
cf the diforders whereof I have fufficiently treated already.
It will be enough for us to attend to the lait part : nor would I have
you believe, becaufe I have faid that a white and thickifh matter was
prefs'd out, that this was any thing elfe but ferum •, which, having loft its
other, and more watry, particles, by ftagnation, and by being taken back into
the blood, the remaining particles become endow'd with that colour, and
thicknefs, which we fee in the evaporation of the ferum.
14. A virgin, of fourteen years of age, having died in the hofpital at
Padua, about the beginning of February in the year 17 19 •, after labouring
under pains of the belly; I order'd the genital parts to be brought to me,
for the fake of anatomical refearches ; and as I found fome morbid appear-
ances therein, contrary to my expectation, I will relate them to you ; after
having firfl pointed out two things that were obferv'd in the belly, while thefe
parts were taken out.
The vifcera of that cavity were here and there unequal with tubercles. The
omentum was thicken'd, and adher'd to the fundus uteri. This lafl-men-
tion'd part was Mill very fmall ; being fuch a one, for inftance, as was proper
for a girl, whom, if you confider'd the pubes as yet fcarcely furnifh'd with
any hairs, you could fcarcely fuppofe to be at the age of puberty.
When I had cut into it, I found the cavity full of a humid matter, of a
white colour ; but inclining to a yellow and greenifh hue. And this being
-wip'd off, the internal furface of the uterus appear'd to be growing out, in
ieveral places, into fmall whitifh tubercles.
Moreover, there was no protuberating corona to the os uteri : and this ori-
fice, and the neighbouring part of the vagina, and the lower part of it like-
.wife, and the hymen, were occupied by a phlogofis ; fo as to make it natural
to conjecture, that thefe inferior parts had been irritated, by the flowing
down of the more fluid, and acrid part, of that matter ^ while the more thick
part, ftagnating in the uterus of the virgin, when in a recumbent pofture, ad-
her'd to thofe fmall tubercles, which either this matter had produe'd, or from
which, perhaps, this matter had proceeded.
15. Call to mind another young woman, the internal furface of whofe fun-
dus uteri I likewife have defcrib'd (/), as unequal with certain tubercles, like
Avarts ; and you will readily conceive that this furface is prone to diforders of
(/) Epift. 45. n. 21.
chat
Letter XL VI L Article 16, 17. 679
that kind: and the fame will be confirm'd by the excrefcences of which I
fhall (peak hereafter.
But do not be furpriz'd, that there mould be a fluor muliebris in a girl of
this age. For in many it has begun about the firlt dawnings of puberty •,
and in fome even much fooner, though rarely ; in the lame manner as the
menltrual flux is obferv'd rarely, but in fact much fooner.
Read in Terraneus (»;) ; to take no notice of others ; the obfervation taken
from a girl of nine years of age, of a noble family, who was cur'd of a fluor
muliebris ; and even an obfervation of another, who being younger than the
laft by two years, was affected with the fame difeafe, and " dilcharg'd, in
" great quantity, a humour like whey not yet clarified : and this with fome
** ardor, and pruritus."
16. As I was demonftrating fome of the parts of an old woman, who had
died in this hofpital of I know not what difeafe, before the middle of Decem-
ber in the year 1744, to the ftudents therein; I happen'd to light on fome
appearances which were preternatural.
The valvule tricufpides of the heart were pretty hard here and there ; nor
were the femilunares without fome hardnefs. And indeed the great artery
had bony fcales internally, in feveral parts.
To the teites fome hydatids adher'd. When I had brought the os uteri to
view, by laying open the vagina-, the border of it appear'd to be divided into
two parts as it were, from the anterior to the pofterior view.
That is to fay, from each fide of that border, a fmall excrefcence was pro-
tuberant ; in which, as in the neighbouring parietes of the cervix alfo, lay hid
fome cells, or if you pleafe, veficles ; and among thefe, one pretty large ; all of
them being full of that very mucus, which is naturally wont to be found at
the orifice of the uterus -, except that this was of a yellow colour.
While I went on in cutting into the cervix, and proceeded upwards, be-
hold from the very fundus uteri fuddenly ifiued a yellowifh ferum •, and this
in fuch a quantity, that you could fcarcely have held it in a fpoon : but how
this ferum was retain'd in the fundus, even when the uterus was taken out,
and roll'd here and there, it was not very eafy to conjecture.
For in another woman, when the fame thing occur'd, I could fuppofe,
that the internal fafciculi of the cervix ; which I faw to be thicken'd, and
plac'd in a confus'd order ; had obftructed the deflux of the ferum.
But this circumftance did not take place here : and the upper part of the
fundus, almoft univerfally, efpecially on its pofterior part, being ting'd of a filthy
colour internally, was, externally, of a black colour inclining to red ; yet this
penetrated but to a little depth if you cut it, and was without any ill fmell.
17. To this clafs you may alfo refer the obfervation on the woman, which
I have given you in the forty-fifth letter (n). For in that the cavity both of
the fundus, and of the continued cervix, was full of mucus of a thinner na-
ture than that which generally is at the orifice ; and even was in this wo-
man.
That is to fay, as from the fundus uteri-, in the virgin, and old woman,
whom I have defcrib'd -, a matter of a white colour degenerating into yellow,
(m) De Glandulis poll. c. 5, cbf. 2. («) N. 16.
4 and
680 Book III. Of Difeafes of the Belly.
and a yellow ifh ferum was difcharg'd ; fo likewife in that woman, the thin
mucus feems to have been difcharg'd from the fame place : for it did not come
from the tubes, which I examin'd in all of them to no purpofe.
But in the virgin ; whom I put down in the firft place (o), for this rea-
fon, beaufe a fluor had really been obferv'd in her while (he was living ; a
white matter was prefs'd out, not from the fundus uteri, but from the lower
part of it-, from the cervix, and from the orifice.
And from thefe inferior places, I fuppofe the matter, and humour, to
have flow'd down in thole women alfo ; one of whofe hiftories I fhall imme-
diately fubjoin, and take notice of the others.
1 8. I examin'd the vifcera of the abdomen of a certain womsn, after the,
middle of March in the year 1741, in the hofpital, and that for the fake of the
anatomy of the parts : for which realbn, I have not made any remark, in
regard to the diforder of which fhe died. Among the natural appearances I
obferv'd the following preternatural ones.
The ftomach extended itfelf quite to the navel. The 'inteftinum duode-
num was very wide. The whole of the uterus was fo drawn to the left fide,
that it could not be drawn back into the middle with the hand, on account
of the refiftance given thereto, by the ligamentum latum •, which was much
more fhort betwixt the left fide of the uterus and the pelvis, than betwixt
the pelvis and the right fide.
The internal furface of the fundus was ting'd almoft of a bloody colour,
as the corona ofculi was alfo ; except that it here inclin'd more to blacknefs.
Befido^ this corona was divided into two fmall prominences as it were. From
the os uteri, and from the cervix, came forth a mucus •, not of the fame
kind which we generally fee, but thick, and almoft puriform.
19. To this clafs, in my opinion, are to be refer'd thole things, which, as
I have written to you on other occafions, were obferv'd by me in other women
(p) ; and alfo in a certain virgin (q). For in the ftrumpet, I faw the ofcu-
lum uteri daub'd over with a certain white and thickifh humour ; not only
unlike that which was in the tubes, but alfo much unlike the femen virile.
And in another woman, in whom the corona ofculi, and the vagina, were
daub'd over with a whitifh matter; this could not have any higher origin
than from the ofculum uteri : for the matter which I obferv'd above the olcu-
lum, was quite of a different nature.
But in a virgin, whofe vagina was more moid with a whitifh and thickifh.
humour, the difieftion of the upper parts fhows it to have come either from
the fame corona, or even from the vagina itfelf: nor does it feem that it could
be accounted for from any other part, in another woman of whom I fhall
write on a future occafion (r).
Moreover, in the corona, ofculum, and neighbouring cervix, that veficles
are ibmetimes prominent, and fometimes lie hid ; which veficles naturally
contain nodiing elfe but a limpid mucus, that may be drawn out into threads,
fuch.as is ken to be pour'd out at thofe places ; you very well know from
thole things which I formerly advane'd in the Adverfaria (j), and at the fame
(0) Supra, n. 12.
(p) Epill. 26. n. 13. & Epiil. 21. n. 47.
(?) Epitt- 34- n- 33-
(r) Epift. 50. n. 51.
(s) I. n. 32. & IV. Animad. 39. & 40.
time
Letter XLVII. Article 20, 21, 22. 68 j
time confirm'd : of the fortuitous formation of which veficles, there is no
occafion here to refute the figment of a modern anatomid; as it has already
been refuted by others.
But what forbids us to fuppofe, that, as we fee in other glands, fo in theli,
alio, by the force of difeafe, inftead of that mucus a different matter may be
ieparated •, fometimes whitifh, and thickifh, and fometimes even watery ?
And indeed, when you read the writings of thole who had feen veficles,
in theft fituations, before me ; you will find that the greater part of the ob-
fervers, as I have laid in the fird of the Adverfaria (/J, had taken them for hy-
datids, from that water which they happen'd to find preternaturally contain'd
in the veficles. And that this water has been fometimes found by me alio,
for the fame reafon, in thole veficles j you fufhxiently learn from the fourth
of the Adverfaria («).
Therefore, as they naturally pour out that mucus •, fo when the fecretion
they perform is become vitiated and preternatural, they may pour out both a
whitifli and thick matter, and a watery matter.
20. But as not only in the lower part of the uterus, but even in the fundus
itfelf, we have feen veficles ; though more rarely ; having the fame mucus in
them as at the os uteri ; a fluor of a watery, or thick and white matter, or finally
a fluor of any other colour, may have that fource in the fundus alio.
And it behoves us here to confirm, by obfervations, what I fay I have
more rarely feen •, efpecially as thefe relate to the excrefcences of the uterus,
of which it follows next in order to treat.
To the obfervation therefore, which you have had in the thirty-fourth let-
ter (x) ; of an excrefcence that was cover'd with veficles of this kind, near
the upper part of the fundus ; and to another which you will have when I
treat of lamenefs (y) ; of a tubercle in the upper part of the fundus, which
confided of a congeries of thofe veficles •, add thefe that follow.
2i. The urinary and genital parts, of an old woman, were brought to me,
when I was teaching anatomy in the college, in the month of February and
the year 1 740.
While I examin'd thefe parts, I obferv'd that the trunk of the aorta was
not without the beginning of bony fcales internally ; although they were very
few, and appear'd like fpots.
The fundus uteri being open'd ; not only where it was neareft to the cervix
did I fee veficles, but a little higher, alfo, from one fide of it, I faw a fmall
cli.lcer, as it were, of thefe veficles hanging down •, which veficles were con-
nected one to another by a whitifh fubftance being interpos'd : from whence
a (talk alfo was form'd, not very fhort nor (lender ; whereby the clufter was
connected to the internal membrane of the uterus, which was found, and con-
fided of the fame whitifh fubftance.
22. But as thefe veficles themlelves •, except that they had formerly been
torn from the membrane of the uterus, by I know not what accident ; and
their mucus were quite in a natural date •, in order to convince you from
obfervations, that the mucus which they contain may fometimes degenerate
from its natural dare (as I have hinted above) either in colour or confidence ;
(tj N. 32. modo indicate (x) N. 33.
(a) Animad. 40. indkata. (y) Epilt. 56. n. 20.
Vol. II. 4 S firft
682 Book III. Of Difeafcs cf the Belly.
firft call to mind, that, when from the ofculum uteri, two excrefcences, as
I have related a little above (z), made up of thefe veficles were prominent,
the mucus in thefe very veficles was of a yellow colour-, and then read the
two next obfervations.
23. I diffected with accuracy, after the middle of March in the year 1717,
the genitals of a virgin of three and thirty years of age.
The uterus, like moft of the other parts, preferv'd its natural (late. For
although the veflels about it were very tumid, and the internal fubftance of it
likewife turgid with blood •, yet that thefe appearances were owinor to the
menftrual flux having been at hand, when the woman died, was plain from
the internal furface of the fundus uteri •, which, when the fingers were
prefs'd underneath, emitted drops of blood, whereto, when wip'd off, others
fucceeded : but this was attempted in the cervix and vagina to no purpofe.
At the fame time that I was making thefe experiments, and demonftratino-
the event thereof to thofe who were prefent, I obferv'd two excrefcences ;
the one in the right fide of the fundus neareft to the neck, the other a little
below, in the fame fide of the cervix.
Both of them were fmall, and made up of fimilar veficles. But upon cut-
ting into them, thofe which compos'd the interior, gave out a natural mucus;
and thofe that compos'd the fuperior, a limpid water.
24. A woman, of feventy-five years of age, was feiz'd with an apoplexy
when fhefeem'd to be very well in health; and by that was carried off within
three days. The abdominal vifcera were the only parts which were brought
into the college, when I was teaching anatomy in February of the year 1735.
There were fome glands of the mefentery (not only far from the annex'd in-
teftines, but particularly more near, where three or four were nigh to each
other, but not contiguous) which being of a natural colour and appear-
ance, did not each of them equal the fize of a fmall bean : this appearance,
in a woman of that age, will perhaps feem furprizing to fome perfons, and
perhaps alfo preternatural.
That the appendicula vermiformis was hollow only for a third part of its
length, and fcarcely that, I have fuffkiently mown in the Epiftolas Anato-
micae (a).
This one circumftance I ought not to omit here ; I mean that, from the
corona of the ofculum uterinum, an excrefcence hung into the vagina, of
the bignefs of a very fmall cherry •, being blackiih and tuberous on its exter-
nal part : in cutting into which I found it to be nothing elfe but a congeries
of veficles, of a fomewhat larger fize •, fome of which contain'd that mucus
whereof I have frequently fpoken, in a natural ftate, and fome contain'd
water.
25. You fee that the fame veficles may fecrete that mucus, when in their
natural ftate, and may alfo fecrete different matters ; and among thefe water ;
if they happen to be vitiated : and that either in the fundus uteri, where they
are more rarely feen, or in the cervix, and ofculum, where they are feen much
more frequently.
And to the corona of this ofculum ; from whence I faw that excre-
fcence confifting of veficles to hang ; perhaps belong'd that large tumour
(a) N. 16. (a) Epift. 14. n. 62.
« " fiuu
Letter XLVII. Article 25. 683
" fill'd with watry cells in feveral places," which Rviyfch (b) defcribes as
being cut out from the genitals ox • woman-, as it was a tumour which
" had its origin from the confines of the os uteri, or about the os internum
M uteri."
But the fluors, of which I have hitherto fpoken, all con fill of fimple ferum.
And fome of thefe I have known to be got rid of by different methods •, and
that not very leldom ; or at leaft to be vaftly diminifh'd : and I have known
one, which from white became yellow, and obftinate to be remov'd, car-
ried off, by a drink in which the herb fopewort was frefh boil'd, being given
for many days •, together with the ule of white amber alio, and the drinking
of wine in which a i'mall quantity of farfaparilla root had been infus'd.
We muft now go on to thofe fluors, in which a purulent (brum is dif-
charg'd. In regard to which, if, as is generally the cafe, they are the effect: of
an ulcerated cancer of the uterus, they are incurable even from the beginning.
And indeed I remember that when I, and a fenior phyfician of no inconfide-
rable fame, confulted together on account of a noble young matron who was
his patient, and afflicted with this dilbrder ; with which flie had been feiz'd no
more than two months before, tho' it was now exceedingly violent; the fenior
phyfician made this conclufion to his fpeech : that the dilbrder indeed was vio-
lent ; but yet as it was recent fomething might be expe&ed from remedies :
yet I immediately fpoke to this effect, after faying fomething of the nature
of the dilbrder, that the very circumftance which left him fome hope, intirely
took it away from me : for a dilbrder of this kind, which had made fuch a
very great progrefs in fo fhort a time, fhow'd by that very circumftance, if it
were not certain that it was incurable even from other fymptoms, that it
would prove unconquerable by all kinds of remedies.
Nor was I deceiv'd in my opinion -t the woman being foon after carried
off by her very fevere and excruciating pains, by continual vvatchings, and a
continual defiux of a fanies, ferous in its confidence, and brown in its co-
lour ; and of a very intolerable fmell ; and by other fevere fymptoms, which
Aetius (r) formerly deliver'd at large from Archigenes : and before him Pau-
lus (d).
In copying of whofe prolix paffage upon thefe fymptoms, Frederic Hoff-
mann (e) forgetting, which is not to be wonder'd at in thofe who write a
great many things, that it was from Arctaeus, has faid in the fecond book
and the fixty-feventh chapter •, which chapter is no where in all Aretasus :
who gives you the marks of this diforder, in the eleventh chapter of the fe-
cond book, of the figns and caufes of chronic difeafes.
Hoffmann fays in the fame place, " that the more modern phyficians have
" not much obferv'd this affection of the uterus •, but that he had obferv'd
" it ibmetimes, juft in the fame manner and with the fame fymptoms as "
are produe'd in that paffage, which I have refer'd to in Paulus.
Whether they have obferv'd it litde, or not, you will judge by their writ-
ings. To me however, it has been frequently feen •, more frequently than I
could with ; not only becaufe it is incurable, but becaufe in fome patients it
{J>) Thef. Anat. 8. n. 102. (/) Medic. Rational, torn. 4. p. I. f. 2. c. 10.
(c) Tetrab. 4. fern>. 4. c. 94. in Thef. Patholog. §. 8.
(d) De re med. 1. 3, c. 67.
4 S 2 fcarcely
684 Book III. Of Difeafes of the Belly.
fcarcely admits of any alleviation •, in whom I fuppofe it articled the vagina
mod : for thefe women having a few ounces of new n ilk, in which a little
of any compofition of opium was diffolv'd, thrown up into the inteftinum
rectum in the evening, obtain'd a very fhort, indeed, but a very defirable repofe.
Yet there was one of thefe to whom it was of no fervice in the beginning of
the night, but the next morning ; and that constantly. If to the fame patient
opium were given, fhe obtain'd a remiflion of her pains indeed, and got fome
fleep •, but this was fucceeded by fuch a flupor of the lenles, that the patient
greatly complain'd thereof.
The fymptoms however, in refpecl: to the fluor, which we chiefly pay re-
gard to here, are fometimes in part various. Read the obfervation of de
Graaf (f) join'd with a diffection, which I am very much furpriz'd to find
omitted in this thirty-fixth fection of the Sepulchretum.
You will fee that a very acrid matter ; but of the colour of the white of
an egg, when " coagulated," had defcended into the vagina from the uterus,
which was, " every where, either ulcerated or fcirrhous."
Or read over again the hiftory that I have defcrib'd to you in the thirty-
ninth letter (g). You will find that a very large fcirrhus, in the cervix
uteri, and almoft the whole vagina, was ulcerated in fuch a manner, that,
from certain parts of the ulcer, a white matter might flow down ; but
that no difagreeable fmell was perceiv'd from ulcers of that kind, even the
largeft and moft deep.
26. I fhould gladly have defer'd that hiftory, wherein we treat of thefe
things which I juft now took notice of, after a profluvium of blood ; the
jfluor muliebris, and the marks of an ulcerated cancer in the uterus ; if I had
not been under a neceffity of producing it among thofe of internal tumours
of the belly.
Other observations of mine, of erofions in the genitals of women, would
have place here alfo ; if it were not more proper to referve them to another
occafion (b).
In the mean while, I will point out to you fome obfervations of others,
which, if you pleafe you may add to the Sepulchretum. In reading over
thefe, you will find, that, in all of them, after uterine haemorrhages, and
purulent profluvia, fuppurated tumours, or ulcers, were found in the uterus.
Thus Maximilianus Preuffius (*), among the cyfts which fill'd the uterus
of his wife, defcribes fuch as " refembled abfeeffes fill'd with a purulent
" ichor, of a green colour mix'd with white, and extremely foetid •" and in
them one which " had, in feveral places, perforated the urinary bladder,
" that was coalefc'd into one vifcus, as it were, with the uterus all round
" about ; and, together with the urine, had frequently difcharg'd a fimilar
" pus from the body •" wherefore the pus did not flow out of the uterus
only, but from both places, though generated in the uterus.
So Jo. Maurice Hoffmann (k) faw " the internal cavity of the uterus
" rnark'd out into a great number of fmall caverns, and loculi •," after wiping
off the pus wherewith the cavity was turgid. So Godofredus Klaunigius (/), in
particular found "a cancerous ulcer" of the fame kind, " in the collum
(f) De Mulier. Organ, c. 9.
(?) N. 33.
(/>) Epi;l. 52. n. 2. & 6.
(*) Eph. n. c. dec. 3. a. 5. & 6. obf. 126.
(k) Earund. cent. 8. obf. 27.
(/) Earund. cent. 3. obf. 65.
" uteri j
Letter XLVII. Article 27. 685
" uteri •, fo that this very collum fhow'd nothing of its own fubflance re-
" maining, but the external coat or membrane : the other parts bein^ in-
" tirely conlum'd."
This lb very confidcrablc confumption of the fubftance of the uterus, with-
in only a fhort time, has often indue'd me to wifh, that, in the obfervation
which I took, notice of in the foregoing letter (m), wherein " the uterus
*' was very fmall like a pigeon's egg, and in a manner corrugated •," in a
woman of about eight and thirty years of age; to wifh, I fay, that the fame
had been difiected.
For as the patient " had labour'd, through the whole of her life, under a
*' fluor albus;" it is, perhaps, not very contrary to probability, to fuppofe that
the fubftance of the uterus had been confum'd gradually, though not from
an ulcer of that kind •, but that the fubftance had been lb injur'd neverthelefs,
and fo wafted away, thac not fo much the uterus itfelf, as the external mem-
brane of it, being corrugated, and fubfiding, it was at length redue'd to
that ftate of fmallnefs.
- 27. After having refer'd you to thefe obfervations, I muft now do what I
promis'd you: that is, I muft go on to confider the fmall beginnings of the
cauies of great diforders of this kind ; and confequently of the caufes of the
fluor ; I mean excrefcences of the uterus, or tumours, that I have obferv'd by
means of diffeclion : not all of them however, but thofe which I fuppofe to
relate molt to the prefent fubject. For they are either external or internal.
Obfervations of the firft kind, which do not fo much relate to the fubject
in queftion, I have taken notice of, briefly, in the thirty-ninth letter (»).
But I fhall here make mention of the internal ones, which are defcrib'd elfe-
where ; and fhall add fome, for which I fhould not eafily find another place.
Thofe tumours however, which grow within the very fubftance of the
parietes uteri itfelf; one of which I have defcrib'd in the forty-fourth letter
(0) ; will be here omitted for this reafon ; that they do not always reaqh to
the cavity of the uterus, though they are greatly increas'd : as appears from
that very large tumour, whereof you will read in the preceding twenty-third
feftion of the Sepulchretum (p).
To the internal then belong; befides thofe minute tubercles which I de-
fcrib'd above (q), and thofe fmall verrucas which I took notice of on that oc-
cafion (r) ; certain fmall excrefcences, of different forms, obferv'd in feveral
uteri (s), one in each ; and others alfo, very low and fmooth ; but more in
number, and of a confiderable circumference (t) ; and in like manner out of
three, two at leaft, which were affix'd to the uterus, by a peduncle of no
flender fize; and were lefs hard in their fubftance than the uterus itfelf; the
fubftance, both internally and externally, being fo full of blood as to be quite
black («) : finally, a fcirrhous tubercle in the corona of the os uteri (x).
But thefe I have written of to you already. Now let us add the others.
(m) N. 21. • (j) Epifr. 12. n. 2. & ep. 23. n. 11 ; & ep .
(«) N. 36. 45. n. 16.
(0) N. 23. (.<) Epirt. ead. n. 17.
(/) Obf. it, §. 2. («) Ibid. n. 24.
(?) N. 14. (.v) Jbid. n. 23.
(>) N. js.
Tet.
686 Book III. Of Difeafes of the Belly.
Yet if you dcfire to know of other appearances, of the fame kind, feen by-
other perfons, you will find, among the reft obfcrv'd by Gvolfg. Hannib.
Langius (y) ; after the uterus had been greatly injur'd by a midwife ; a certain
fcirrhous tubercle, flopping up the orifice thereof to fuch a degree, that there
was no pafiage for the difcharge of flatus ; nor any admiffion for the probe:
and you will alfo find, that, by the younger du Verney (z), a glandular body
of the bignefs of a nutmeg was found within the uterus of a dropfical virgin.'
Others I purpofely pafs over : and immediately go on to my obfervations
that ftill remain.
28. A woman of a middle age, had died in the hofpital of St. Mary de
Morte at Bologna, of a diforder of the thorax, in the latter end of April of
the year 1706. As I examin'd the vifcera of the belly in this woman, I ob-
ferv'd the following preternatural appearances in the genitals.
The lower part of the vagina, where it lay neareft to the orifice of the
urethra, retain'd fome traces of an ulcer : and thefe were flill more ma-
nifeft in one of the labia pudendi. Thefe appearances gave me a lufpicion
of a lues venerea having preceded, as an excrefcence at the anus alfo did i
which confided of a kind of white fubftance.
Turning my eyes from thence to the ovaria, and tubes, I faw the former
to be of a whitifh colour, and corrugated ; the furface being hollow'd out, in
fome places, with furrows drawn in a ferpentine form.
When I cut into them, I found them to be fomewhat hard : and in one of
them was an empty cell, which was comprehended in two coats ; the one inter-
nal and black, the other external and cineritious : in the other, befides fmaller
veficles full of moifture, were two pretty large cells, in an empty ftate, one of
which had a coat that was become in part bony •, but the other had a coat
that was become perfectly bony, and fo furrow'd as to refemble fome of the
folds of the fmall inteftines as it were.
To one of the tubes, a corpufcle, in its fliape and confidence fimilar to
the chryftalline humour of a fmall fifh, when boil'd, adher'd externally ; and
to the other, a congeries of the fame kind of bodies, though far more fmall,
adher'd. The uterus was large, and had thick parietes •, but in particular the
fundus.
The cavity of this vifcus was much more large tranfverfly, about the mid-
dle of its length, than it generally is •, and in that part, or rather a little more
pofteriorly, the anterior furface of the uterus on one fide, and the pofterior
furface, were connected together by the interpofition of a thin membrane ;
but from the oppofite fide an excrefcence began, which being fix'd to that
one place, and unconnected in other parts extended itfelf in the form of a
circle, the diameter of which was fomewhat larger than the breadth of a man's
thumb.
The thicknefs of this excrefcence was inconfiderable ; the furface beino-
diftinguifh'd here and there with red fpots : and as to the fubftance, it was
almoft the fame as that of the uterus itfelf, except that fomething of a mu-
cous fubftance feem'd to be intermix'd with it ; which made it more eafily
admit of diftra&ion.
XyJ Comm. Litter, a. 1735. hebd. 29. (*) Mem. de l'Acad. R. des Sc. a. 1703.
The
Letter XLVII. Article 29, 30. 687
The cavity of the cervix, both at its beginning, and termination, was
much more ltreight than it us'd to be. But from the beginning of this ca-
vity, and on the oppofue fide to the excrefcence I have defcrib'd, hung an-
other very fmall cxcrela nee ; of the fame fubftance as the other •, but in the
whole of its furfacc of a red fa tu rated colour, and of the figure of a pear
hanging by its ftalk ; except that, on its anterior and poflerior iurface, it was
flat.
29. This fecond excrefcence, by reafon of its form, brought into my mind
thofe uterine polypi, which Ruyfch {a) delineated ; as growing out from the
lower part of the cervix, and pendulous therefrom •, after that obfervation,
which you will be furpriz'd to find not transfer'd into the Sepulchretum ;
when you call to mind the great quantity of acrid fluor that was join'd with
thefe appearances.
And as excrefcences of this kind, jufl: like polypi of the noftrils, may be-
come cancerous and malignant, and have a malignant ulcer join'd with them ;
that obfervation furficiently teaches and demonrtrates, that it is not without
juitice we here confider excrefcences of the uterus, as being capable of giving
origin to thofe very bad diforders.
And with that view I (hall add four other examples to this •, all feen by
me when I was giving public lectures in anatomy : the firft of which will be-
long to the fame clafs with this lower, and fmall one, and the others to that
upper and larger excrefcence.
30. In the year 1728, I directed a woman, in whom was a peculiar
venous trunk •, but not very fmall ; parallel to the trunk of the vena cava
on the left fide ; communicating on one hand with that trunk, where it
receives the iliac vein, and on the other with the emulgent vein ; which vef-
fel I fliall perhaps defcribe at another time and in a more convenient place-,
as I (hall alfo fpeak of the parts that lie neareft to thofe veins, among which.
was the trunk of the great artery, that fhow'd flight beginnings of bony
fcales, on its internal furface •, for I mean now to fpeak of the genitals only,
in which I found the following appearances.
The ovaries, or, if you pleafe, the teftes, were fmall : one of them was
very much contracted, and the other indeed contain'd no veficles, and but
a very few cells ; the lefler of which, except that they had nothing in them
worthy of remark, were fimilar to that larger one, which feem'd to compre-
hend, within a thick coat, of a yellow ifh colour inclining to white, a finus in
the form of a pretty long duel:, which fent out very fmall ramifications tranf-
verfly : although I was afraid, left the coat, which formerly, perhaps, had
contain'd a fpherical cavity, being afterwards collaps'd, and contracted into
itfelf, might, by the interception of its own rugas, have given the appearance
of that duct, and of thefe ramifications.
Looking at the alae vefpertilionum, in order to demonftrate the nervous
plexufifes therein, in one of them 1 met with the flighted and mod fmall be-
ginning of the plexus as it were ; but in the other there was not even this.
At the ofculum uteri was a kind of prominence of a green colour. A little
above, from the paries of the loweft part of the cervix, hung, by a fliort and
(a) Cent. Obf. Anat. Chir. Fig. 6. ad obf. 6,
whitifh,
688 Book III. Of Difeafes of the Belly.
whitifh ftalk, a fmall excrefcence fmooth in its furface, and of a red colour
inclining to brown ; lefs oblong indeed in its figure, but, in other refpects,
very fimilar to that fmaller excrefcence, which was lait defcrib'd in the woman
above.
31. A woman, of fifty years of age, or upwards, having receiv'd a wound
upon her head, died on the thirtieth day after that^ which was in the begin-
ning of February in the year 1738. I could fcarcely examine any other part
but the genitals. In which I oblerv'd the following things.
The teftes were confiderably hard, dry, and without veficles. Although
they were not at all different from each other, in any refpect, yet the nervous
plexus was much lefs in the right ala vefpertilionis, than in the other. The
fundus uteri, when open'd, fhow'd upon its lower, and pofterior furface, a
fmall excrefcence, nearly of the form of a circle, deprefs'd, and, in its fupe-
rior part only, disjoin'd from the internal membrane of the uterus. And of
this very membrane it feem'd to be an excrefcence, rather than of the fub-
ftance of the uterus.
For cutting through this excrefcence, the fubjected paries of the uterus,
and that membrane; and comparing one with another-, I found the excre-
fcence to be made up of the fame more compact fubflance that the membrane
was : befides, I found it of the fame fmoothnefs externally, and of the fame
colour as that membrane; if you except only the upper edge, by which I have
laid it was disjoin'd, for this alone was red.
32. As I was looking upon, and confidering, thefe appearances, a fufpicion
came into my mind, that this excrefcence, and others of the fame kind, were,
perhaps, nothing elfe but the internal membrane of the uterus, rifing up in a
certain place, from a nine months adhefion of the placenta ; and particularly
in thofe, from whofe uterus it had been pull'd away with any kind of vio-
lence.
For in this manner it may be conceiv'd, why thefe excrefcences are of a
circular form ; and why not equally manifeft in all women that have born
children.
And I remember'd to have read in Ruyfch (b), thataltho* the protuberances,
" which are found in cows that are pregnant ;" and which are " nothing but
" a uterine efflorefcence, that, in the time of gravidation, is rais'd up into a
" tumour, in that place where the foetus is connected to its placentulse;" are
not feen in women, " while they are in a ftateof pregnancy ; yet in that place
" where the placenta applies itfelf to the uterus, that the internal coat of the
" uterus fometimes, alfo, raifes itfelf up into a tumour, infome meafure."
But, on the other hand, I obferv'd that Ruyfch does not feem to have at-
tended to this circumftance, that in cows thefe protuberances exift from the
very birth, and are only inlarg'd in pregnancy like the other parts of the
uterus ; nor do they vanifh away afterwards, when the empty uterus con-
ftringes itfelf: whereas this flight tumour of the internal uterus in women (in
regard to which, we fhall confider, on another occafion, of what nature it is,
and whether it be from that coat of the uterus) does not appear to us, before
the placenta has applied itfelf to the uterus in a very clofe manner; nor after
{6) Thef. Anat. 5. in fin. Arcula 3. n. 1.
the
Letter XL VII. Article 33, 34. 689
the uterus has properly contracted itftlf on cxclulion of the foetus ; nor in-
deed docs Ruyfch fay that it then appears to him.
But I remember'd in particular, that excrefccnccs of the fame form had alfo
been found by me in virgin uteri; or at leall in the uteri of thofe who had
never born children : as in this hiltory which I fhall immediately fubjoin.
33. An old woman ; who had been taken into the hofpital, on account of
an ulcer of the leg; flaying there very contentedly, had the fame thing hap-
pen to her, which frequently happens to others likewiie : that is, (lie was, in
confequence of the impure halitus, feiz'd with a fever-, which was at firft,
as feem'd by the previous cold, of an intermitting kind : but foon after,
when it could not be reftrain'd by the Peruvian bark, it became continual and
acute, and was attended with fome delirium. The woman was therefore car-
ried off by it.
And, in examining almoft all the vifcera of this body, about the middle of
February in the year 1736, I remark'd thefe few things which feem'd to be
morbid.
The pia mater of the brain had its vefTels diftended with blood, and could
be very eafily drawn out of the deep furrows, which are upon the furface of
that vifcus.
The great artery, after going out of the heart, both above the valves,
and in other places ; as, for inftance, where it ran down through the belly •,
fhow'd, internally, the white beginnings of future fmall bones.
That the uterus had never been pregnant, appear'd from the inflection of
the hymen •, which though it was low, was entire •, or, at lead, had never
been lacerated. . And the fame thing was confirm'd by the internal ftructure
of the uterus, when laid open ; being, in a great part of it, juft as it is in
thofe who have not born children.
Yet the internal and pofterior furface of the fundus, which was tranfverfly
dilated, was cover'd over, at its upper part, with an excrefcence of a circular
figure : which, beginning from the right fide itfelf, terminated at no great
diltance from the left •, fo that the diameter of it was not much lefs than that
in the woman of Bologna, who was defcrib'd above (c).
But it was not, like that, free and unconnected, if you except a fmall part
■which belong'd to the left and lower border : the remainder of it adher'd to
that furface of the uterus which was juft now fpoken of. The thicknefs of
this excrefcence was inconfiderable •, the furface of it was fmooth, and its co-
lour externally bloody: internally it confided of a whitifh, compact, and firm
fubftance.
34. I examin'd the urinary parts, and the parts of generation, of a cache-
tic, and almoft dropfical, woman, about the end of January in the year 1749 ;
when I found the following appearances in particular.
The left kidney had its furface unequal, here and there, with many cells
which were full of ferum •, or rather with middle-fiz'd, or very fmall, hy-
datids.
For although they were, in great part, buried within that vifcus, fo that
none of them reach'd to the pelvis ; yet they were alfo prominent outwards :
(0 N- 7-
Vol. II. 4 T fo
690 Book III. Of Difeafes of the Belly.
fo that fome of them, which had burft afunder, might, by pouring out their
ferum, into the cavity of the belly, add fome new materials to the incipient
afcites.
The other kidney had none that was~confpicuous on its furface ; for one;
which was of a middle fize, and v/ithin the lubftance ; was contain'd betwixt
the furface and the pelvis, without reaching to either. The urinary bladder •>
at lead at its lower part •, was univerfally.red, and inflam'd, from a great num-
ber of fmall veflels being crowded together.
But as to the genitals, a tumour of a fpherical figure had form'd itfelf upon
the uterus ; the diameter of which tumour was equal to an inch and half.
The greater part of the tumour was prominent on the outfide of the ute-
rus : the letter part was fo buried in the anterior paries thereof, on one fide,
as not to reach to the cavity of that vifcus.
It was univerfally hard, and internally white •, the whitenefs, however,
being variegated in feveral places with fpots, that were lefs white. The in-
ternal furface of the cervix was white, and unequally tuberous •, if I may be
allow'd to fpeak thus •, but that of the fundus was red, and rifing up into
two flight prominences, neither of which was red, except on the furface.
35. To thefe four obfervations •, which, as I faid, were made in the col-
lege •, I choofe to add another which I made in the hofpital, about the mid-
dle of December in the year 1748.
36. A middle-ag'd woman had died there, who was faid to have labour'd
under a melancholic delirium, and a flight fever, at her own houfe, for a
long time : nor yet could we know this for certain •, nor from what caufe fhe
was, at length, at the point of death, when fhe was brought into the hofpi-
tal. It will be your bufinefs then to conjecture, from the preternatural ap-
pearances which I obferv'd, in examining almoft all the vifcera, by what dis-
orders fhe was carried off.
The body had a pretty good appearance. The cerebrum ; to begin with
that ; had no peculiar hardnefs : but I found the cerebellum to be lax. Withr
in the cranium I no where found any water.
Nor did I obferve any thing very confiderable in the thorax. Even the
lungs were not, in any part, connected to the pleura, by the flighteft attach-
ment. In the heart was fcarcely any coagulated blood-, and in the great veffck
none at all : but I faw a fmall quantity of blood come forth from the aorta,
where it begins to defcend.
In the belly, however, were many things that I obferv'd. And firft, when
the abdomen was laid open, blood was found in the hypogaftrium, betwixt
the mufcles ; being coagulated and grumous, as if it had been the confequence
of a contufion : the caufe of this appearance was unknown ; nor did any
recent injury, in the cavity of the belly, correfpond to that place;
The fpleen was of fuch a length, that beginning from its ufual fituation,
rt reach'd quite to the os ilium ; with which very great length the other di-
menfions did not agree. It was lax, and not livid, but red in great part.;
at leaft on its anterior furface.
The gall-bladder was diftended with a great quantity of bile. There was
fome water in the lower part of the pelvis. The bladder internally, at the
2 orifice
Letter XLVIII. Article i. 691
orifice of the urethra, and a little above this ijpace, was diftinguifh'd witlr
fanguiferous veflels.
The uterus was a little inclin'd to the left fide •, and yet the orifice of its
ofculum, upon laying open the vagina •, which was almoll universally livid,
and fmelt very ftrong-, was more on the right fide, than this inclination
feem'd to account for. And the caule of this was, that the corona of the ofcu-
lum, which was harder than is natural, was increas'don the left fide by a kind
of tumour.
37. But of excrefcences, and internal tumours, of the uterus, enough at
prefent •, left thefe letters mould be increas'd to an immoderate fize, as I
have faid is to be fear'd.
You eafily perceive, however, that it is not furprizing, if from diforders of
this kind, which are lb frequently found, the worft of tumours, by the addition
offome other accidental caufe, are fometimes form'd ; and from thefe, when
ulcerated, if incurable fluors are brought on. In the next letter I mall treat
of the remainder of womens diforders. Farewell.
LETTER the FORTY-EIGHTH
Treats of falfe Pregnancy, Abortion, and unhappy
Delivery.
IF you mould happen to be furpriz'd, that I give no more than this one
letter to fo many arguments of that kind ; you will be ftill more fur-
priz'd, when you find that no more than two, and thefe not very long lec-
tions, that is the thirty-feventh, and thirty-eighth, are allow'd in the Se-
pulchretum •, not to thefe fubjects only, but to many others at the fame time ;
among which are the origin of twins, hermaphrodites, and the marks of
virginity.
Thefe fubjects I think are not proper to be treated of here-, where the in-
tention of proiecuting the plan of the Sepulchretum requires it ; left I mould
treat of other things befides the hidden caufes of dileafes, inveftigated by
anatomy : and if 1 were to treat of them, the greater part of triofe things
which are faid, in the Sepulchretum, thereon, would have very little, or no
weight with me.
But left you mould fuppoie me to fay this without good reafon, I will give
vou fome inftances of what I affert.
4 T 2 For
692 Book III. Of Difeafes of the Belly.
For what has that obfervation of Gerard Blafius (a) to do with the origin
of twins •, I mean that in which he makes no hefitation to confider the vefi-
cles of the teftes, not to fay, probably a kind of hydatid that adher'd on
the outfide of one of them, as eggs ?
Or what has the fubjoin'd appendix to do with this fame origin ? For in
this •, to omit other things that do not differ from the opinion of Blafius ;
•' the aura leminalis is carried through the vas deferens, or ductus brevis," that
is the round ligament of the teftes, as I fuppole, quite to the teftis itfelf;
as if the females of quadrupeds were not without this ligament : " the
" oviducts of hens" are faid to be " (trait and pretty lax -, but in man nar-
*' row, and very tortuous •" as if, although they are considerably lax in hens,
they were not, at the fame time, fo much the more tortuous, in proportion
as they are longer than the tubes in women ; that is in a proportion which ad-
mits of' no comparifon.
And thefe things are added ; the connexion of the tubes with the teftes
ought to be more nicely inquir'd into, left thofe appearances which we call
jagged edges, fimbriae, or morfus diaboli, may be the effects of rupture ±
that is to fay, left the tubes, having, perhaps, previoufly adher'd to the
teftes, in a natural ftate, " mould have been torn away therefrom, by care-
" Ieflhefs, during the extraction of the teftes •," as if the tubes confided of
a membrane extremely thin, and their fimbriae were of fuch a ftructure, and
figure, as to be capable of being produc'd in that manner : there is betwixt
the cervix uteri, and the teftis, another duct that carries the femen, " which
*' might not improperly be call'd cervicalis ;" as if it were not certain that
a duct of this kind was nothing more than fome fanguiferous vefTel : finally,
not to take up too much time-, through the round ligaments of the uterus,
" the feminal matter, and other excrementitious matters alio, that are col-
" lected in the uterus, are expell'd to the groins •," as if it were not mani-
feft, that thefe ligaments do not communicate with the cavity of the uterus.
And thus far upon the origin and generation of twins.
And pray what relation to hermaphrodites have thofe three diflections [b) ?
fince with a female pudendum, was join'd a penis which was neither furniih'd
with any urethral orifice, nor emitted urine ; fo that, even without any dif-
fection, it was certain that this penis was nothing more than a clitoris of a
monftrous magnitude.
Finally, in refpect to the marks of virginity, it would have been better to
fay nothing at all than to propofe thole two, or three, obfervations (c), in the
latter part of the thirty-eighth fection •, from which the.reader in part icarcely
knows, what is not to be reckon'd among thofe marks, and partly believes,
that even the hymen itfelf (which however is the principal of all the marks of
virginity) is not to be number'd in that clafs •, efpecially as in the adjom'd
Scholium it is faid that the caruncles alone may be confider'd as that princ pal
r irk, and the reader is refer'd no Lis to Pinzeus the afferter of this opinion,
than to others.
But what is my opinion on thefe points, I think I have the iefs occafion to
(a) 4. in feft. 37. (c) Obf. 7 & 8.
(£) Ibid. obf. 6.
take
Letter XLVIII. Article 2.
693
take any notice here, becaufe I have fufficiently faid, heretofore, in the Ad-
verlaria (a), what I had obferv'd ; and what is my judgment on the fubject
or virginity appears in that refponlc entitled fupra Judicio Objletricum de Millie-
ris Virginitate.
2. And even in the thirty-eighth fection, there are not a few things which
either ought not to have been introdue'd in that place, or, if added, ought
to have been entirely amended by ibme animadverfion.
Nor indeed can we make the lame apology for thefe things, that may per-
haps be made for the greater part of thole we have made remarks upon
above ; I mean that at the time they were pubiifh'd, no better things had
been as yet advane'd : although even then much better things had been pub-
iifh'd •, and ftill more lb, at the time in which the Sepulchretum was re-
printed, and increas'd.
For without doubt, there was no need of recent obfervations, that thefe
things, fome of which I fhall point out immediately, might not be produe'd
without emendation.
In the firft oblervation, for inftance ; to omit that fome things, in the dif-
feclion of a certain foetus (e), are fo propos'd, that, although they are natural
appearances, they may be fuppos'd, by the greateft part of readers, to have
been the effect of a vitiated ltructure ; who can bear (f) that the funiculus
umbilicaJis of foetuffes, " is wont to be generally, and in all, of the length
" of fome tils ?" Or who can think it " wonderful (g)" that a woman, who
had mifcarried feven times, mould have produe'd " all her abortive foetuffes
•5 juft of the fame magnitude; that is nearly equal to a joint of a thumb ;
" though fometimes at a longer, and fometimes at a fhorter, diftance from
" the time of conception ," who, I fay, can fuppofe this to be " wonder-
" ful," unlefs any one who does not underftand that the abortions were dii-
charg'd at different times indeed, but all died at the fame time ?
For that a dead foetus may be retain'd even many months in the uterus,
and without any corruption, or bad fmell, is fufficiently fhown •, befides other
obfervations, and particularly thole that are to be met with in Ruyfch (b) ;
by that which immediately follows (i).
And in the fecond obfervation 'yk), when a certain foetus, whofe egrefs had
been prevented by a tumour of the paffages, was found to have his cranium
comprefs'd on one fide; this inference is drawn from it: " from which it
" clearly appears, not only that the expulfive force of the uterus has an effect
'* towards the protrufion of the foetus, but alfo that the infant endeavours
" to rree itlelf from the confinement of its prifon :" is this deduction of a
matter, which, of itfelf, is in other refpects not falfe, clearly prov'd to you :
fir.ee the mother is faid, " to have had labour pains for five or fix days," and
the iniant to have given no figns of life after the firft days of thofe pains ;
fo that it is by no means certain whether that comprcflion of the cranium is to
be afcrib'd to the efforts of both mother and infant, or to the efforts of the
mother alone.
(d) h n. 59. £, IV. animad. 23 & 24.
CO S- 3
Cf) ~
Kit §• -1-
{h) Thef. Max. 11.40. 158. 210,
W 7-
W J-
But
694 Book III. Of Difeafes of the Belly.
But let what I have faid be fufficient. For you yourfelf, in reading over
the fourteen examples •, which are produc'd in the firft observation, in fuch
a manner, as if" all of them related to abortion •, will be at no lofs to deter-
mine whether the lecond, which relates to mature delivery, ought to have
had a place among the reft-, and flill lefs, whether all the oblervations that are
collected under number nine relate to the prefent purpoie •, as the greater part of
them, at leaft, have no reference to the preternatural, but to the natural, ftate
of the uterus, both in gravid women, and thofe who have lately born
children.
But this is a lubjecl on which you muft exped nothing from me here. For
thofe things which I alfo have obferv'd, in refpect to that ftate, more
than once, and with fome accuracy, belong to a work quite different
from this.
However, though I have, with ingenuoufnefs, and in order to be of ufe
to your ftudies, made thefe ftrictures on the feftions of the Sepulchretum I
have fpecified ; I neverthelefs very readily confefi-, that there are many things
in thefe fections, which deferve approbation.
And the heads of thefe I (hall follow in this letter ; at the fame time
however, interpofing, or adding others, which I mall fuppoie to be necef-
fary, and to relate to the prefent fubjecls.
3. And firft in regard to falfe pregnancy ; it is too well known that phyfi-
cians are not uncommonly deceiv'd, either in taking the true for the falfe,
or the falfe for the true. But I could wifli that certain figns always exiftcd ;
for in reliance upon thefe, learned and attentive phyficians, at leaft, would
not be in danger of falling into either of the errors.
The fign of true pregnancy, that is the motion of the foetus in utero, is
certain, and obvious, to the hands, and fometimes even to the eyes : and any
one who has once properly perceiv'd this, by the application of his hand to
the abdomen, efpecially when cold ; for by this means the motion is ge-
nerally excited ; will never fuffer himfelf to be impos'd upon by flatus of the
interlines, nor any other motion whatever ; fo peculiar is that motion, and
of fuch a nature, that it cannot be produc'd except by the body of a living
foetus.
Yet, in the firft months we not only want this fign ; but the others alfo
fometimes; and now and then even in thelaft months, by reafon of the weak-
nefs of the foetus ; or from other caufes.
I remember that I was formerly afk'd to go and fee a young woman,
who, from the time that a furgeon had taken away a cancerous tumour, as
they faid, from her breaft, had her belly begin to fwell •, which was now
nine months. The lefs reafon I found, upon examining her, to fear, from
any of her fymptoms, that a cancerous tumour was reviv'd in the uterus ;
as was then fuppos'd ; with fo much the more time and care did I examine,
with my hand, the tumid uterus.
As the uterus feem'd to be impregnated, but I felt no motion there-, and
as the prefence of her relations did not fuffer me to afk for cold water, to dip
my hot hand in -, for the weather was extremely hot -, I calt'd afide the phy-
fician of this young woman, and although he afferted that he had never felt
any motion in the belly, I advifed him neverthelefs, that notwithftanding
every
Letter XLVIII. Article 3. 695
every one fupposM the patient to be an untouch'd virgin, he fhould a6t with
c.uition, and circumfpection ; and not to forget what had happen'd in others
like her, a lew years before, to the great reproach of the phyticians who
attended.
Do you defirc to know the event ? This untouch'd virgin foon after
brought forth a child. The fign that I have fpoken of therefore is a certain
fign when it is preient ; and yet the woman may be impregnated when it is
not obferv'd.
Another fign I have read of as propos'd by men in other refpects learned,
and experiene'd, for a certain one ; and one that occurs in all gravid women •,
I mean the navel protuberating, on the contrary to what happens in a drop-
fy, and all other tumours of the belly.
But does it never protuberate in an afcites, though fome perforate it,
when protuberant, in order to draw off the waters ? And in like manner is
not the caufe that they ailign, of the navel being prominent in pregnancy,
common to other tumours whereby the inteftines are fore'd upwards ?
But it is needlefs to make thefe and other inquiries, as they themfelves
confefs, that this fign does not exift before the end of the third month •, and
as it ibme times moreover happens, that utero-geftation is join'd with a
dropfy.
Not to take notice hereof the matron mention'd by Platerus (I), who was
wont, " as often as fhe was pregnant, to fall into a dropfy ;" there are few
phyficians who have not feen both of them join'd together fometimes ; or
who, at leaft if they are prudent and cautious, not being ignorant of the er-
rors of others, have doubted whether they might be join'd together.
For which reafon I was the more furpriz'd fome years ago, that a phyfi-
cian, in other refpe&s learned, and a man of great experience, being in con^
lultation with me for an illuftrious matron •, who had come hither when la-
bouring under an afcites and anafarca ; fhould have fpoken fo as to be feli-
citous about nothing elfe, but about immediately prefcribing the moll effec-
tual remedies againft both thefe dropfies.
I, however, feeing that the matron had young children, and was herfelf
(till in the prime of life ; and not being able to inform myfelf, for a cer-
tainty, whether flie was then pregnant or not; thefe medicines, faid I, I uni-
verfally approve, provided, however, that they are not begun ta be made
ufe of, before it is quite clear as to this circumftance whereof I am inquir-
ing ; and in the mean, while let fome more gentle remedies, and fuch as are
fafe on both fides, be made ufe of; and in particular a proper method of
Jiving.
The woman was wife, and liften'd to me ; and after having return'd home,
lent, at a proper time, to return me thanks, and to inform me, that, hav-
ing brought forth a fon, fhe was at the fame time freed from both thofe
difeafes ; and that nothing thereof remain'd but a tumour of the legs.
There are, Ifee, many likewife who depend upon a very ancient fign ; I
mean one that is propos'd in theaphorifms of Hippocrates (m) ; " thofe who
" are pregnant have the os uteri comprefs'd :" a mark certainly that is not to be
(I) Obf. . I. 3. ubi de Extuberantia, {m) Sett. 5. Aph. 52.
defpis'd5
696 Book III. Of Difeafes of the Belly.
defpis'd, and is very ufeful in thofe firft months, in which there is no room,
as I have faid above, for the former.
Wherefore I have made ufe of this fign with fuccefs, when it was in my
power •, but I had it in my power very feldom ; the women of our country be-
ing, for the moil part, repugnant to an examination of that kind. Yet I
have not made ufe of it without caution, not being ignorant that there are
diforders of the uterus, wherein, as Hippocrates in part teaches («), the os
uteri is clos'd.
And for the fame reafon I did not believe it to be fufHcient, if a fkilful
examiner perceiv'd, that, to fome conftriction of this orifice, fome increafe
of the corona was likewife added-, or if, having forc'd this corona upwards
with his finger, and foon after drawn it away gradually, while the woman was
in a ftanding pofture, he obferv'd, on fuffering the corona to flip down again,
the uterus to be pretty heavy ; or, finally, if he perceiv'd the fame orifice
to be inclin'd towards the pofterior parts.
For although thefe things, with the addition of the fign of Hippocrates,
certainly increafe the force of that; yet I judg'd that there was no great de-
pendance to be plac'd upon them •, unlefs when that corona, as Galen (0)
formerly admonifh'd, was not harder than is natural, and all fymptoms of
difeafes, and affections of the uterus ; in fome of which, at leaft, there
is an inclination forwards, whereby the ofculum is turn'd backwards; were
wanting.
4. That we may not, therefore, take a true pregnancy, for a falfe one, we
muft have a peculiar regard to the figns that are not prefent, as well as to
thofe that are ; and above all, if the woman has been pregnant before, we
muft confider whether the figns, from which (he judges herfelf to be preg-
nant now, are the fame that had preceded in the beginning, at other
times.
For by reafon of this circumftance being defpis'd ; which is fometimes .
fallacious indeed, but not to be neglected for that reafon ; I have feen phyfi-
cians fall into an error, as you will clearly conceive, from three obfervations
at leaft, which I choofe to fubjoin. All thefe obfervations relate to women
of rank ; the firft to one of this city, and the others to women of my native
city.
5. A foetus had been conceiv'd fix months and fome days ; for from that
time the woman had not convers'd any more with her hufband ; the mother
not doubting, by reafon of the uneafy fymptoms which Ihe had ufually fuf-
fer'd, after other conceptions, but that fhe was really with child.
And now the uterus had begun to fwell in the third month, when, a great
quantity of blood being difcharg'd from the haemorrhoids, the fwelling was
confiderably abated ; fo that it was in general fuppos'd the woman had been
deceiv'd.'
Wherefore, although fhe afterwards found her belly fwell again, as foon as
fhe had gather'd her ftrcngth after the ceafing of this flux ; fne was not for
that reafon fuppos'd to be pregnant. At length the fame flux return'd, and
a fever came on befides.
(*) Ibid. Aph. 55. (») De Loc. Affett. 1. 6. c. 5.
And
Letter XL VIII. Article 6, 7. 697
And then neither fhe herfclf, nor her phyficians, fufptcting any thing of
pregnancy •, blood was taken away from her arm, and afterwards even from
her toot : after which a medicine was, alio, given to open her bowels.
A few hours after this had been given, behold ! contrary to the expecta-
tion of every one, a dead foetus was difcharg'd ; and feven hours after that
the fecundines. And thefe, together with the foetus, were brought to me
on the following day in the morning; which was the twenty-ninth day of
Auguft, in the year 1727 j when 1 alio had the cafe related to me.
The foetus, from the crown of the head to the foles of the feet, was of a:
length equal to the breadth of fix fingers : the funiculus umbilicalis was
nine ; but of a furprizing flendernefs, lb as to refemble a thread of a mo-
derate thiclcnefs ; being without any intorfion, and every where equal.
The body of the foetus, which was of the male lex, was well-form'd both
internally and externally ; except that the whole head was of fuch a figure,
that it feem'd to have been compreis'd on the fides.
It had been of a white colour at the time of its difcharge, but was now
become brown. Almoft all the vifcera were pallida and nearly deftitute of
colour ; and in particular the liver, which was of a flight yellow,, degenerating
into a great palenefs. The urinary bladder was empty; and not only this
but the inteftine colon and the rectum.
Although nothing of blood, and indeed nothing of a bloody colour, ap->
pear'd in any part of the foetus, wherever you cut into it, or of its funiculus ;
which was brought to me in an entire ftate, being connected on one fide to
the navel, and on the other to the placenta ; and although the firft branches,
at leaft, from this rope into the placenta, were (lender ; certain large globes
as it were extending themfelves fomewhat in lengthy of a blackifh colour,
and diftended with almoft fluid blood, were, neverthelefs, feen through the
membranous furface of the fecundines, where it lay under the placenta ;
which in this fubject was really very large in proportion to the fmallnefs of.
the foetus.
However, although the body of the foetus was neither externally flaccid,
nor cover'd with rugous integuments; nor any difagreeable fmell proceeded
therefrom, or from its fecundines ; I neverthelefs did not doubt but it had
either lain a confiderable time dead in the uterus, before the dilatation of its
orifice; or, at leaft, that it had lain in a very weak ftate, and like a Head,
foetus, before it was quite dead.
6. The fudden efflux of a great quantity of blood had, as appear'd from
the diiTeclion, render' d the foetus, and its funiculus, bloodlefs ; and the lat-
ter likewile fo exceedingly flender. However, as there was fuppos'd to be
no foetus at all in this cafe, the error of the phyficians becomes fomewhat more
cxcufable, than in the nexthiftory.
7. A foetus that was, in like manner, immature, and dead, had been
ejected by another matron,, in the month of Auguft, in the year 1716. This
woman fuppofing herfelf pregnant from her ufual fymptoms, the phyfician,
in order to diminifh the blood, which, as he thought, abounded, took away
the weight of a pound from her arm.
As her belly was not afterwards inlarg'd, in proportion to the time of her
pregnancy ; and the woman did not perceive the motion of the child, at the
Vol. II. 4 U time
698 Book III. Of Difeafes of the Belly.
time that fhe had been ufed to perceive it •, both the midwife, and the phyfician
himfelf, otherwife a learned man, but not cafily giving up an opinion which he
had once imbib'd, pronoune'd that it was not a rectus which fhe bore in her
uterus, but a mola, or falfe conception.
The mind of the woman being alarm'd at this pronunciation, and afflicted
with very great fadnefs, it happen'd accidentally, that I withdrew, during the
filrrifner, into my native place : and being ignorant of thefe things, I was
brought to her by fome noblemen who were her relations, and very intimate
friends of mine : and this at her requefl.
When 1 faw her to have a good colour, as fhe ufually had, and, except the
fadnefs of her countenance, to be in good health •, what need, faid I to her,
have you of a phyfician ? Why, faid fhe, that he may inform me whether
I am with child or not.
Then afking the proper queftions of her, and examining her belly with my
hand, and hearing and feeling nothing, from whence I might not fuppofe her
to be with child ; and learning from iier, and even from her waiting-maid,
who had always attended her chamber, that every thing was now, and had
been, the fame as in her former pregnancies, if you except thofe two things
that I mention'd jufr now ; you are with child, faid I ; nor do I think thofe two
circumftances would have been wanting, if you had not done what you did
not in former pregnancies, when you was much younger ; I mean if by let-
ting blood in fuch a quantity, you had not diminifh'd the ftrength of the
foetus, and retarded its increafe.
After this at length I heard who had ordefd this bleeding, and the opi-
nion that had been pronoune'd in regard to the falfe conception. Then faid
I, what realbns this gentleman may have for his opinion I do not know : but
I have not one that inclines me to fufpect a mola, or falfe conception •, yet I
affirm that you are pregnant with a foetus, which is in a weak and languid
ftate, and which, unleis you recruit yourfelf, and it, by a proper method of
living, and by chearfuinefs of mind, you are in great danger of not carrying
till the proper time of your delivery.
Thefe things were true, but inculcated when it was too late. For I hav-
ing gone into the country for fome time ; it happen'd not many days after,
that the woman, without expecting it, hadfomewhatof a bloody difcharge from
her genitals. And the phyfician, in confequence of his prejudice in favour
of his own opinion, order'd her to ride in a coach pretty fwiftly, and over rug-
ged and uneven places.
From thence arofe pains. The patient return'd home. Somebody was im-
mediately difpatch'd to the phyfician, to coniult him what fhould be done.
The phyfician prefcribes a clylter, and fays that he will come by the time this
has had its effect. While the clyfter was difcharg'd, a dead foetus is dif-
charg'd at the fame time, together with the fecundines ; but without any falfe
conception.
Not long after comes the phyfician. The maid, of whom I fpoke before,
runs to meet, and accolts, him, almoft in the fame words which were us'd
on an almoft fimilar occalion, formerly, to her phyficians, as you have it in
the Sepulch return (_/>), by that noble Venetian matron Helena de Mocenicis.
(p) L. 3. f. 21, in fchol. penult, ad obf. 58.
For
Letter XLVIII. Article 8, 9. 699
For the maid fhowinghim the foetus, laid, Look here, this is the falie concep-
tion that my miftrels bore.
The foetus it was out of my power to didec!; being abfent, as I have al-
ready laid. But I heard, from thofe who law it, that it was Qender, and had
no ill fmell.
8. Yet phyficians deferve to be forgiven, if they do not join obftinacy with
a falie opinion. 1 found one to be much more docile in the fame city, as
you will immediately perceive, from the hiftory of the cafe which happen'd in
the year 1721.
9. Now take a third hiftory of a foetus, that was difcharg'd by the mother
in an immature and lifelels ftate ; which hiftory defcrves to be written with ft)
much the more accuracy, becauie a mola was difcharg'd at the fame time,
and thofe things had preceded, which; as in a certain obfervation of Scha-
cherus (q), that in fome meafure agrees with this ; almoft remov'd the opinion
of true pregnancy.
A matron of a (lender habit, and fmall ftature ; but than whom I never re-
member any one to have generated more blood ; and the happy mother of many
children, yet fometimes alfo fubject to abortions ; having, after her laft de-
livery, which was follow'd by a very great difcharge of the lochia, pafs'd
the winter in a dejected and gloomy ftate ; in the month of April fuppos'd,
from the tokens which fhe had been accuftom'd to perceive, join'd with a re-
tention of the menfes, that fhe had conceiv'd again.
Thefe fymptoms were follow'd by fo great a lofs of appetite, that (lie only
ate in the evening in general, and that with difficulty ; and whatever fhe took
in the morning was thrown up by vomiting.
To this was added, about the thirteenth of June, a flux of blood from the
uterus; againft which diforders ; not altogether new or unufualtothe patient;
notwithstanding the ufe of the waters of Nocera had been of advantage,
at other times, after trying many things in vain, it was of no advantage now.
For thefe reafons then, I was call'd to the patient about the middle of July.
As fhe had the mod unfpeakable averfion to blood-letting, I therefore re-
commended fuch things as fhe would not obftinately refuie ; as for inftance
the ufe of jellies of calves feetr coral redue'd into a fine powder, cydonites,
and a few other things of the like kind, which might counteract both the dif-
orders ; yet in fuch a manner as not to reftrain the flux of blood with vio-
lence.
In the mean while, both the diforders continued ; yet fo as to be born with-
out difficulty. For every day in the morning fhe role from bed, fat, walk'd,
and even, when fhe pleas'd, was carried through the city in a coach (though
this was what I did not much approve) and fcarcely any blood was dif-
charg'd.
In the night only, when fhe lay either fupine, or on her left fide; for on
her right fide fhe could not lie ; was it difcharg'd ; whether the heat of the
bed excited the difcharge, or whether, when fhe was not in a recumbent pof-
ture, any thing oppos'd itfelf to the ofculum uteri which cover'd it, or in a
manner ftop'd it up.
Befides that which had been difcharg'd in the night, there was a large
(?) Progr. de Haemorrhag. Gravidas
4 U 2 quantity
700 Book III. Of Difeafcs of the Belly.
^quantity of coagulated blood, which came away when fhe firft rofe. In th?
mean while, to her other caufes of grief was added one very violent, join'd
■with fadden terror, on account of an unexpected misfortune of her hufband •,
which, as the whole city heard it with commiferaiion, fo his wife heard -with
<ears and wringing of hands.
On the firft night, indeed, after this calamity, the flux of blood was almoft
intirely ftop'd. But during the following nights, it flow'd more plentifully
than before. There was now no perlon who, confidering fo great, and fo
frequent, an effufion of blood, could believe it portable for the woman to
be with child *, and even fhe herfelf believ'd it no more.
The phyfician however, although my fenior, liften'd tome, who frequently
urg'd that we muft for a while withold our opinion, in the cafe of a woman
who abounded, to fuch a degree, with blood : that all the ufual figns of preg-
nancy had preceded; that no traces of abortion had ever yet appear'd in the
effus'd blood, though it had been always accurately inipected : that the uterus
fwell'd (lowly indeed ; but if the blood fhould at length flow more fparingly,
it then would probably be elevated in a very little time.
We muft endeavour therefore to render the difcharge more moderate ; for
that by this means the ftrength of the patient might alfo be more eafily pre-
ferv'd, the decreafe of which was already to be argued from the patients leo-s
not being fo ftrong as they had hitherto been, and from the rofy colour of her
countenance being diminifh'd.
As other things, which he had adminfter'd with this intention, did not an-
fwer very well ; he began to give the old conferve of rofes, as it is call'd,
vitriolated, with which and the confe&io alkermes; for fo it is call'd; with-
out perfumes, he involved citron-feeds bruis'd, and reduc'd them into the
form of a bolus.
With this bolus not only her appetite began to be fomething better, but a
much lefs quantity of blood was difcharg'd. And then ; for a third part of
the month of Auguft was now pafs'd ; not only the breads began to fwell, as
in former pregnancies, but even to be rais'd up very high.
Here then, the patient herfelf, and others, began to return to the opinion
of pregnancy, which they had given up. Yet there was fomething unufual
that made the patient and me both uneafy ; that is a frequent fenfe of prick-
ing in the uterus. And on this account I was inclin'd to examine her belly
accurately with my hand.
In doing of which I became ftill more uneafy, as I perceiv'd the uterus
not to be accuminated towards the navel, but more extended in a tranfverfe
direction on both fides, and not bearing the touch without pain, if it were
prefs'd upon pretty ftrongly ; efpecially at the right iliac region. I not only
diffembled my fufpicion with the patient by words, but even by my coun-
tenance, as I thought it my duty to do.
I open'd it however to the phyfician, and to her hufband, by faying that
I fear'd left there fhould be a falfe conception befides the foetus ; and yet that
there need be no alteration for this reafon, in the method of treatment : for
that where there was a fufpicion of a falfe conception, and the increafe of the
uterus was larger every day, in proportion as the lefs blood was difcharg'd,
there was not any room for fuch things as aftring'd violently ; efpecially as
4 the
Letter XLVIII. Article 9. 701
the blood, in fome nights, did not flow very fparingly, yet for the rr.ofl part
of them with fufficient moderation at prefent : nor, on the other hand, where
the very great discharge might eafily return, and there was fuppos'd to be a
foetus together with the talle conception, mult we have recourle to forcing,
and Hi mulating, medicines, which are not always iafe, even where there arc
■falie conceptions only •, but that the ftrength of the woman mult be preferv'd,
by observing the itate of the flux, and moderating it according to occafion ;
and, at the fame time, by keeping the patient quiet both in body and mind,
and nourilhing her with aliments fuitable to her condition.
While thele things then were obferv'd with attention, not many days
after, when the patient happen'd to be ltanding (which was on the eighteenth
of Augult) the waters fuddenly broke forth from the uterus, not differing in
their fmell, nor in any other circumltance, from thofe which generally are dif-
charg'd by women in labour ; except perhaps that they were difcharg'd in
fomewhat larger quantity.
The midwife being immediately call'd, and finding no figns of an ap-«
proaching birth, befides this eruption ; and even perceiving, with her finger,
the os uteri to be fhut •, took care we ihould be inform'd of thefe things :
and we anfwer'd that unlefs any thing new fhould arife, we mult in the mean
time lie {till and do nothing.
One, two, even three, days were pafs'd over in this manner. I not being
greatly furpriz'd at it, as I remember'd not only to have read the fame in
Harvey (r\ and many other authors, but alfo to have feen in another noble-
woman, and fellow-citizen of mine, the difcharge of the waters long before
the latter part of utero-geftation ; the birth not fucceeding, neverthelefs,
till the proper time, and being happy •, yet I was fomewhat dilpleas'd with the
accident in this cafe, where I fuppos'd the foetus to be neither robuft, nor
folitary.
But on the fourth day, when the belly, which had been much funk by the
difcharge of the waters, was again fomewhat more elevated, labour-pains
came on : the mola was firft excluded, and after that the foetus in a lifelefs
ftate •, and laft of all, after the interval of three hours, the fecundines came
away not without difficulty, and a great profufion of blood.
The mother was preferv'd, and died nine and twenty years after, of a ma-
lignant ulcer, as I have heard, in the uterus or vagina j but one which had
begun in thefe later years.
At leaft, at the time fhe was pregnant with this foetus, and even in the
time that fucceeded her delivery, and for a confiderable length of time after-
wards, there was no fymptom from whence you could juftly fufpeel: any ul-
ceration of the uterus, or vagwia ; and from thence account for thofe effufions
of blood ; as you might in a woman defcrib'd by Raygerus (j), fince fhe la-
bour'd under a very great uterine haemorrhage firft, together with very fevere
pains of the loins, and groins, fix or feven weeks before her delivery ; and
after her delivery, and time of child-bed, was afflicted with a profluvium of
(r) In additam. ad exercit. dc generat. «bi (*) Eph. n. c. dec. 3. a. 3. obf. 135.
de uter. humor.
very
702 Book III. Of Difeafes of the Belly.
very foetid and black matter, by which fhe was wafted away within a very
few months.
But if you choofe to compare our cafe with thofe propos'd by Phil. Jacob
Hartmann (/), and by the celebrated Guttermann («) ; you will eafily conceive
that abortions, which are, in like manner, join'd with a falfe conception, have
been preceded by a very great, and very long, profufion of blood -, and yet
that this is not, and could not, with propriety, be attributed to a blood-vef-
fel being open'd in the vagina, and much lefs to the ulceration of the uterus,
or vagina.
But let us go oa to confider the other circumftances relative to the abortion
I have defcrib'd.
The mola being wafh'd from the blood which adher'd to it, was found to
be no thicker than two fingers breadths ; but fomewhat longer •, and when cut
into, appear'd to be a little fpongy, and in a manner flefhy.
The fecondines fhow'd no diforder at all. The foetus, which was of the
female fex, was not equal in its length to nine inches. The whole of
the head and neck was blackifh, as if from a large contufion •, but without
any ill fmell. The other parts, even internally, had no preternatural ap-
pearance, as far as I could fee.
For, by reafon of the foolifh morofenefs of the women, I was but juft al-
low'd to open the belly, in which I obferv'd the ftomach, and fome of the
inteftines, to be not empty, from what they naturally contain'd of a blackifli
colour.
But they would not even have permitted this, except for the fake of com-
forting the parents •, who, being deceiv'd by the appearance of the fex, were
greatly chagrin'd at their having loft a boy ; for 1 fhow'd them the uterti3,
which was very fmall indeed, but very evidently communicating with the
rimula of the pudendum •, as I demonftrated to thefe curious parents ; ac-
cording to my promife, by introducing a (lender probe through the external
paffage •, for the pretty prominent magnitude of the clitoris, covering over
the rimula, as is uiual in foetuffes of this kind, had impos'd upon them for
*. penis: nor is this furprizing, fince it has often impos'd upon lurgeons, and
even phyficians, in the fame manner.
10. And you will know that this is not faid without reafon by me, when
you obferve that the author of both the fpeculations upon viviparous gene-
ration, defcribes a foetus in one of them, which, " having fcarcely attain'd
" to the length of a third part of the little finger, was neverthelefs compleat,
M and diftincl in all its parts-, lb that even the mafculine fex was extremely
" well diftinguifh'd."
For he would not have fallen into this error « which thefe words extremely
well, without any mention of doubt, or of a more accurate examination,
plainly fhow •, if he had been more ftudious of exercifing himfelf in anatomy,
than of oppofing it ; and had obferv'd the fame things that fkilful anatomifts,
and particularly Ruyfch (x), have taken notice of, in regard to the deception
in diftinguifhing the fex being more eafy, for the reafons I have faid, in pro-
portion as the foetus is lefs.
(/) Dec. ead. a. 4. obf. 84.
(u) Acl. n. c. torn. 3. obf. 78.
(x) Thef. Anat. 6. n, 48. 51. 54. 59.
It
Letter XLVIII. Article 10. 703
It concerns parents to have this vulgar error extirpated, as they very often
fuffcr the more chagrine on account of an abortion, becauie they think
thole to be the abortions of males alio, which arc in fact the abortions of
females.
But to return to the hiftory in queilion, whether that blacknefs of the head,
as if from a contufion, was owing to this, that the waters being altogether,
or in the chief part, effus'd, the membranes were not dtftended thereby ;
and therefore not pulh'd downwards in order to dilate the paffage for the
foetus ; but the foetus being propell'd by the efforts of the mother, was
oblig'd to open a palfage ror iticlf through the (freights of the os uteri ; or
rather whether, if the foetus is fuppos'd to have been previoufly dead, which
was certainly the cafe, it might have contracted an injury of that kind, (to
which only living bodies, or recent carcafes, are liable) long before •, what-
ever the caufe of this might be; or immediately after, death, the head being
probably turn'd downwards before-, and, in like manner, whether the mola
is to be accus'd, which, as it preceded the foetus, might have been interpos'd
betwixt the head of it and the os uteri, and have made the way more narrow j
and might likewife be the obftacle which, when the woman was in a (land-
ing poiture, prevented thedifcharge of blood from the uterus, as it feem'd to
be then prefs'd upon the orifice from above ; I leave quite undetermin'd.
And I do not doubt, but the waters which were effus'd, came from the
amnios of the fame foetus, which was not excluded till the fourth day after
for feveral reafons ; but particularly becaufe they feem'd to be in fomewhat
greater quantity, than they ought naturally to be.
Nor am I ignorant of its having been ingenioufly fuppos'd, that the waters
which are dilcharg'd before their proper time, do not belong to that foetus
which is, at length, protruded ; but to another : which having been con-
ceiv'd together with this indeed •, but extinguifh'd in the firit dawnings of
life, and afterwards colliquated ; has left the waters that anticipate the dif-
charge, within its own proper amnios, till, by their continual increafe, this
membrane is fo diftended, that it can no longer refifl" the pretty vehement
motions of the other foetus ; which is flrong, and almoft arriv'd at a ilate of
maturity.
But not to difpute here, upon that increafe of the waters, and moreover,
to grant that there may, perhaps, be fome room for this hypothefis in fome
cafes •, at leail there certainly was not in our cafe ; inafmuch as the foetus was
imperfect and weak ; nor yet in thofe propos'd by Peterfonius (y) and De-
thardingius (2); for the foetus which is laid to havedrawn back, into the ute-
rus, its head which was already thruft out, and to have remain'd there-, the
one two weeks, and the other feven •, till they were intirely excluded at the
time of birth, had certainly open'd a paflage for their own waters, and not for
thofe of others : or if thefe inftances requir'd more firm proofs, which I readily
confefs; yet others more eafy to be believ'd, and relative to the fame fubject,
will not be wanting, if you mould have leifure to inquire after them.
However, I am wont, for the moil part, to account for that diicharge of
(y) Eph. n. c. dec. 1. a. i.obf. 62. (x.) Earund. dec. 3. a. 5. in append, n. 8.
ad cit. obf. 6z.
waters,
704 Book IIL Of Difeafes of the Belly.
waters, which is premature, and generally harmlcfs, from the rupture of the:
chorion alone ; which by this means fuffers the water, that was, perhaps, col-
lected betwixt itfelf and the amnios, in greater or lefs quantity, according to
the obfervations of Ruyfch (a), and of others (£), to flow out ; although thefe
perfons have, from thence, feign'd to themfelves I know not what kind of
allantois in the human fpecies.
But that the eruption of waters, before their proper time, which Hippo-
crates (c) with reafon pronoune'd " bad," is from the amnios itfelf, I- do not
in the leaft doubt. Although the birth is not always unhappy after this : yet
it is generally lefs happy than it would otherwife have been, whether we con-
fider this as a caufe, or as an effect.
For confidering it as a caufe, the water, being effus'd, does neither then
properly dilate the pafiage for the foetus, nor lubricate it. And as an effect;
whether it be from the membranes of the fecundines being not quite firm,
or from the too great quantity of water, or finally, from the acrimony of it
(in which light Martianus (d) choofes rather, and not without juftice, to con-
sider it, when he teaches us how to diftinguifh thefe two laft from each
other) it certainly does not foretell any thing good, in refpect to the confti-
tution either of the foetus, or of the mother, or both, in their lblids, or
fluids, or both •, contrary to what is requifite to the defir'd happinefs in child-
birth, and in child-bed.
From thefe confiderations it will be eafy for you to explain fome things re-
lating to the eruption of the water, and to the other circumftances, in the
cafe of the matron in queftion ; in her delivery, and in the foetus^.
And as to the figns which indue'd me to fufpect a falfe conception,, you
gather thefe from the hiftory, where, fuch as they are, I have taken notice
of them. It certainly is not fo eafy to know that it is prefent, as to allow us
to affirm it with boldnefs : yet from the known figns which our anceftors have
left us, we may fufpect it with prudence.
The greater part of thefe; though it is not neceflary that all of them fhould
occur together ; you will fee collected by Lamzwerdius (e), from whofe book,
otherwife in the greateft part of it quite barren, I have obferv'd them to be
defcrib'd by fome authors, in this age, without mentioning his name.
Yet I did not fuppofe that mola, either before delivery, or after difiection,
to be one of thofe that are call'd the true ; and even always confider'd it as a
polypous concretion of the uterus, particularly in a woman (and this circurn-
ftance indue'd me ftill more to fufpect its exiftence) from whofe uterus I law
fo great a quantity of blood was difcharg'd ; and found that this blood was fo
prone to concretion.
11. Without doubt, though fome of the molae are true, and others that
are fo call'd are fpurious •, yet fome of both thefe kinds may be either join'd
with a foetus, and often caufe abortion ; whether by irritating the uterus, or
(a) Thef. Anat. 5. n. 56. prope fin. & thef. (cj Coac. praenot. feft. 3. vcrf. 187.
10. n. 155. (d) Annot. ad eund. verf.
(b) Vid. Littre Mem. de l'Acad. R. des Sc. (e) Hift. Nat. Molar, uter. c. )6.
a. 1701. & Commerc. Littr. a. 1732. hebd.
36. n. 3.
by
Letter XLVIII. Article 12. 705
by occupying a very confidcrable part of its cavity ; or increafe to fuch a de-
gree, without a foetus, as to refcmble pregnancy.
But the illegitimate, or fpurious, may be produe'd even in untouch'd vir-
gins, and chalte widows ; the legitimate, or true, cannot, unlefs among
thole, who, contrary to the opinion of others, fuppofe cva fubventanea^ 01
unimpregnated eggs, in women.
The fpurious ; to fpeak of thefe fir It ; are form'd either of blood ftagnat-
ing in the cavity of the uterus, or of fome internal excrefcence thereof. You
will know thefe latter by a certain bafis, or peduncle, by which, as Ruyfch
(f) has advane'd, they are continued from the uterus, or at lead come off from
the fanguiferous veffels thereof, which are produe'd into them.
But the former, which occur much the molt frequently, and to which you
will, without difficulty, refer many that are extant in the Sepulchretum, are
compos'd merely of blood •, in the fame manner as other polypous concre-
tions are form'd in the vefiels, and in the heart itlelf : and I do not fee furfi-
cient reafon, why we may not allow it poffible, as Lancifi (g) has taught,
that thefe may be form'd even in the uteri of virgins, contrary to the opi-
nion of Hoffmann (h) ; efpecially in the uteri of thofe whole menftrua How
in great plenty, or to whom a uterine hzemmorrhage is not unufual ; for in
this, or fome fimilar manner, do I think that the celebrated Abraham Vater
(/') is to be interpreted ; as he allow'd of them in fome virgins at lead.
Ruyfch (k) has taught us, by what means concretions of this kind may be
diftinguifh'd from certain molfe, which have, by others, been reckon'd among
the true ones j and this notwithstanding they have fomething join'd with them
that has a refemblance to membranes. But before I begin to expatiate a little
upon molas, I mull not conceal from you, an obfervation of mine of. a cer-
tain fingular conformation of polypous concretions of the uterus.
12. In the place of my nativity was a noble matron, of a tall ftature, en-
dow'd with a good colour, and a laudable habit of body, who had fuffer'd
feveral miscarriages in the firft months of her pregnancy ; but in the inter-
vals of thefe abortions, however, fhe had frequently completed her period of
utero-geftation, and brought forth very large living children, and even fome-
times twins ; thought not without great difficulty, and troublelbme times of
child-bed.
Betwixt thefe difficult births fhe had, for the mod part, been fubjett to a
fiuor albus of an innocent nature; and, fometimes, in the midway betwixt
her menftrual purgations, to a flight ftillicidium of blood alfo, which the em-
braces of her hulband, efpecially when rather more violent, renew'd : and
not without fome confiderable pain.
This woman then, when fhe had pafs'd about her thirty-fourth year, being
intirely rid of her fluor albus ; began to labour under a new kind of difeafe
at intervals, which recur'd frequently, within the fpace of two years : but
in the three laft months of the year 1723, and the firft of the following year,
in which month I was confulted by letter, it return'd at a certain time ; thac
is at the time of the menftrua.
(f) Cent. obf. anat. chir. 58. (i) Did", qua mola pregnane &c. tlief. 12.
(g) Epift. ad Mulebancher. [k) Cent, citatpe obf. 29.
{b) Diflert. de ignor. uteri ftxuft. §. 19.
Vol. II. 4 X For
706 Book III. Of Difeafes of the Belly.
For at that time pains, like thofe of child-birth, coming on; and the flux
of blood beginning on the firft or fecond day, and flowing even more plenti-
fully than ufual •, in almoft the middle of its courfe a membranous body, as in
appear'd, was difcharg'd from the uterus : and that in fucha form, and of fuch
a magnitude, as perfectly correfponded to the triangular cavity of the uterus ;
being moderately convex externally •, on which furface it was unequal, and
not without many filaments that feem'd to have been broken off from the
parts to which they had adher'd ; but internally hollow ; on which furface it was
fmooth, and moift, as if from an aqueous humour, which it had before con-
tain'd, but had difcharg'd, at its own exit, by an ample foramen, which was
in one of its angles, that had been readily open'd by rupture.
The exclufion of this body was follow'd by a great quantity of the lochia ;
and thofe were often interrupted according to the cuftom of women. And if
this body came away fometimes, not in an entire ftate, but divided into little
pieces, and at different times •, then the pains, and the flux of the lochia, were
in like manner renew'd at thefe times.
As the patient therefore, in each of thefe four months, in which fhe had
abftain'd from the embraces of her hufband, had fuffer'd one of thefe very
troublefome kind of abortions •, and the remedies which had been prefcrib'd
by many excellent phyficians, who had been confulted, had been of no ufe
at all ; fhe began to think that it would be much more advantageous to her,
if fhe could be free from the pains for nine months at leaft ; and determin'd
to lie alone no longer: wherefore in the month of March 1724, fhe became
pregnant. Yet fhe did not carry her foetus beyond June.
But this was the confequence of it; that in July, and the two following,
months, her menftrua flow'd properly, and without any uneafinefs.
However, as none had appear'd in the month of October, the pains re-
turned again about the beginning of November, with the difcharge of fuch
a body as I have defcrib'd ; and with the other circumftances I have fpoken.
of above.
And the fame fymptoms continued to return a long while, at ftated inter-
vals ; fo that when I was at Forli, in one of the following years, I faw a body
that had been difcharg'd, which, as I had written to them when abfent, was
made up of a polypous concretion refembling a membrane, and difpos'd into,
the form of a fmall triangular purfe : fo that it was eafy to conceive, that the
vifcid particles of the ferum of the blood, iffuing forth from the uterine ori-
fices of the veffels, which had been formerly difcharg'd in the form of a fluor
albus, were now become more vifcid, and adher'd to all the internal parietes
of the uterus, and by this means were concreted into a polypous membrane;,
and being moulded to the figure of that cavity (which, in the Adverfaria (/),
I have affirm'd to be almoft of the figure of a triangle) as if taken from a
real mould, refembled a purfe, into which the watry part of the ferum, that
had been betwixt thofe more vifcid particles, being exprefs'd, was retain'd ;
preferving the purfe hollow, and rendering it internally fmooth : and that
they were retain'd with eafe, becaufe, either on account of the fafciculi of
fibres that protuberated within the cervix, or on account of the narrownefs
(I) I. tab. 3 & IV. animad. 42..
of
Letter XLVIII. Article 12. 707
of this part, if compar'd with the fundus, or by realbn of the impediment
of the orifice, which was almoft cloie, the vifcid particles ftagnating, and
being every where contiguous to one another, (hut up the purle from the
very beginning : and finally, that this, at full, by oppofing an obftacle to
the blood which was about to burn: out every month, caus'd the veflels of
the uterus to be diilendcd, and pains by this means to be excited ; but after
that, when by the force of the impelling blood, it was drawn away from the
parietes of the uterus, it increas'd the pains and made them violent ; and laft
of all that being torn quite away on all fides, it was thrown out of the uterus,
not without a great quantity of blood preceding, accompanying and follow-
ing it, on account of that great diftention of the vefiels.
Thus you have the opinion that I had of this difeafe, in the beginning,
and afterwards : which difeafe, to me who remember'd the obfervations of
Platerus (w), and of others, and thole which were not unknown even formerly
to Aetius (/;), feem'd by no means new, in this circumftance, that, at the
dated time of the menftrua, fome concretion mould be dilcharg'd, and that
for a long time together •, but in this, that the concretion was of fuch a pecu-
liar form, which I do not remember to have read of in other authors : and
indeed I remember Platerus to have exprefly aflerted, that he could find
" no cavity" in his concretion.
To fome of thole who were confulted, this of ours feem'd to be an excre-
fcence of the uterus ; to others a polypous concretion indeed ; but from blood
diftilling through fome eroded vefiel, in the uterus itfelf.
But if they had either infpected it, as I did, or had read the defeription
thereof, in the letters written to me by this lady's hufband ; which were much
more accurate than thofe of the phyfician •, I doubt not but they would readily
have laid down thofe opinions, which time, alfo, fhow'd to be foreign to the
truth.
For although the difeafe lafted along while afterwards; yet it at length
ended of itfelf, and through the effects of age.
That is to fay, when the time was come, in which the menflrual purga-
tions generally leave women, it now firfl began to return, not every month,
but only twice, or thrice, every year : and when the menftrua entirely ceas'd,
it ceas'd alfo : nor did any fign of even the moft flight erofion in the uterus,
or any inconvenience therefrom, exift during the whole life of the woman ;
and fhe liv'd until a caneer, which arofe in one breaft afterwards, carried her
off" when on the verge of feventy years of age.
Moreover, the opinion of the phyfician, whom this patient made ufe of,
was that thefe concretions were unimpregnated eggs •, confidering, I fuppofe
the fame thing that they did, who have taught us to diftinguifh polypous
molae, from thofe which are from fuch eggs, by the cavity which would be
■within thefe latter, and not within the former.
But if we were even to allow of fuch eggs in women •, it would neverthe-
lefs be difficult to fay, why, in this woman, they fhould always be drawn
(m) Obf. 1. 3. ubi de inanimat. excret. (») Medic. Tetrabi. 4. ferm. 4. c. 80.
4. X 2 out
708 Book III. Of Difeafes of the Belly.
out into the form of a triangle, and why in each month, one Ihould be ready
to defcend into the uterus at a ftated time.
But thus far on this fubject. Now let us add a few things upon true
molae, as I have promis'd.
13. The moft learned men of our age only call thofe molas true, or legi-
timate, which are not produc'd without a previous conception. But fome
believe that they may be form'd of the fcetus, and fecundines •, others of the
placenta only •, if from any caufe whatever, the appearance of thefe parts are
chang'd, fo that they cannot be readily known to be thofe, which from the
original formation they had been ; whether they reprefent a kind of flefhy
mafs, or even a mafs much harder than flefh; or a congeries of veficles \
as that which Mercatus (0) faw formerly.
You have Ruyfch in your hands, who has mown, even in the placenta
alone, both thefe kinds of changes •, and that in feveral places, but particu-
larly in his obfervations : and as thefe were publihVd in the year 1690, I do
not fee why none of them, that I have refer'd to here or above (p)> are trans-
fer'd into the Sepulchretum •, at lead to increafe the fcholia of this fection.
For he has taught us (q), that the placentuls, of very fmall foetuffes,
frequently remain in the uterus •, and being comprefs'd by the uterus con-
ftringing itfelf more and more, feem to be very different from what they
were ; and not only in figure, but alio in their fubftance, which is very fimi-
lar to the moft hard flefli.
And that the placental of pretty large foetuffes, remaining "in the fame ca-
vity, fometimes degenerate into veficles full of a watry humour, the fame
author, if any other, very clearly fhows •, fince he found one and the lame
placenta in part found (r), and in part already chang'd into veficles of this
kind.
But notwithftanding thefe obfervations are true, three or four things, how-
ever, ought to be added.
Firft, that the placentula? of the fmaller fcetufles do not, however, fail to
degenerate fometimes into veficles •, as the fame author Ruyfch demonftrated
the beginnings of this change in the placentula of a fcetus " of al moft three
" months ;'* and in another " placentula Ihow'd the fame change ftill more
« clearly" (s).
In the fecond place, that this change does not agree with the placenta
alone •, fince it is certain, not only from the later obfervations of Ruyfch, that
he had feen a veficle " many times " in the funiculus umbilicalis (t) ; but it
is even manifeft, from his more early obfervations (u), that the fame funicu-
lus had fometimes occur'd to him in a ftate fo full of " veficles, that the
" whole of it feem'd a concatenation of veficles fill'd with a watery humour :"
and it is even certain from the obfervation of our Vallifneri (,v), that a placenta
was difcharg'd from the uterus, after a very great number of veficles, fo that-,
(0) Sett, hac Sepukhr. 37. obf. 1. §.4. [t) Ibid. n. 45. & tab. 2. fig. 3..
(/>) N. 11. (a) Obf. 14. & fig. 15.
(?) Obf. 28. 29. 58. (*) Opere torn. 2. p. 1. ubi de fartu Vefi-
(?) Obf. 33. cular.
(s) Thef. anat. 6. n. 102. 103. &tab. 5. fig.
vnlefs
Letter XLVIII. Article 13. 709
unlefs you fuppofe this to have belong'd to another foetus ; it would appear
that thefc veficles, therefore, had not been from the change of the placenta ;
which you may alio infer from the obfervations of others: as, for instance,
from thole of the celebrated Guttermann (y).
In the third place, that it may perhaps be doubted with the (lime Vallif-
Heri, who I ice has obfeiv'd nearly all the things that I have obferv'd, whe-
ther that degeneracy, of the placenta into veficles, is brought about at the
time when it remains in the uterus, after the exclufion of the foetus ; or whe-
ther it is brought about before this exclufion.
At leafb, in the placenta of a foetus of four months, which had been ex-
cluded together with the foetus, I have feen a veficle full of water. Yet on
this fuppofition, i'uch a change would be feen more frequently in the pla-
centae, which 'are difcharg'd with the fcetufles.
Finally, in the fourth place, as it is laid above, that neither of thefc kinds
of moLc are produe'd without a preceding conception, and neither of them,
certainly, by untouch'd and pure virgins •, that I remember to have read •,.
there is, beyond a doubt, need of the greateft fkilfulnefs, and diligence in
examining ; nor lefs prudence in pronouncing; if at any time a woman who is
faid to have abftain'd herfelf from man, mould, difcharge a body from the uterus,.
which, at firft fight, might feem to belong to one or the other kind j left it
fhould perhaps not be a placenta, but a mere concretion of blood, or fome
excrefcence which bore a refemblance to flefh, or the veficles, whereof I have
fpoken.
For that excrefcences, which refemble flefh, or are really flefh, have been
met with at times is very well known : and what they are which bear a refem-
blance to thefe veficles, has been faid in the preceding letter (z)..
And indeed, as there is fometimes a dropfy in the cavity of the belly from,
hydatids ; as, for inftance, fuch as Ruyfch {a) has reprefented to have beea
included in a peculiar fac-, fo it is not repugnant to probability, that a
dropfy of the uterus is fometimes produe'd in the fame manner : efpecially
as Aetius (b) has defcrib'd this ; unlefs it is to be confider'd as a mola made
up of veficles, as others have chofen to confider it ; in his chapter De Uteri
Hydrcpe : his words are, " a quantity of moifture is collected in the womb,
" and fometimes certain corpufcles, very fimilar to the gall-bladder, are ge-
*' nerated therein, and in thefe corpufcles a humour is collected :" and thefe
^corpufcles he calls below " bladders compos'd of pellicles, and fill'd with,
" water."
Nor are examples wanting, of a long-continu'd dropfy being folv'd by a very
great number of hydatids difcharg'd from the uterus •, one of which kind
you will read propos'd by the celebrated KannegiefTerus (c), in an old \vo-
rnan who was about feventy years of age : although there may be fome who
fufpeft, that,, in this cafe alfo, thefe hydatids belong'd to a true mola ; that
is to fay from the placenta of the foetus, conceiv'd while the age of the wo-
man as yet allow'd of it, and carried in the uterus many years after the death,
of the foetus.
(>•) Aft. n„ c. torn. 3. obf. 78.
(■z) N. 20. & feq.
(a) Obf. cit. fig. 24.
(b) Med. Tetrabibl. 4. Serm. 4. c. 74.
(c) Aft. n. c. torn. 6. obf. 89.
Which:
710 Book III. Of Difeafes of the Belly.
Which I take notice of for this reafon, becaufe the celebrated Rideux (d)y
in regard to the mola of another kind indeed •, but of the legitimate kind, as
he does not doubt •, which was difcharg'd by a widow in the feventy-feventh
year of her age-, although of fuch a magnitude and weight, that it is fur-
prizing, no figns of its existence had ever been given •, thinks, neverthelefs,
for thole reafons which he gives, that it had its origin from a conception of
the woman, when fhe was in her fifty-fourth year : that is in the year when
her menftrual purgations, being not at all diminifh'cl quite to that time, ceas'd
of a fudden : and fhe had brought forth her ninth child in the fifty-firft; year
of her life.
And thefe things being fuppos'd, you may gather two ufeful inferences
from thence. One, that we may confider, whether you can from hence ex-
plain, or at lead in fome meafure, hew the woman of whom you read in
Vallifneri (e) ; who was herfelf alfo the mother of many children -, the laft of
which fhe was fuppos'd to have brought forth almoft in her fiftieth year-, in
the feventy-fecond year of her life at length difcharg'd a placenta from the
uterus, and, annex'd thereto, a mafs, weighing a pound, of rude, and un-
form'd flefh ; if you except a kind of fimilitude to an eye in the upper part;
and certain involutions within, as if of the inteftines of a foetus : and, in
like manner, how another woman (/),' older by a year than the laft-, who
had formerly had her menftrua return, and been impregnated, and had them
return now again for one month or two ; difcharg'd " veins -," if they were
really veins, and could preferve their form fo long ; together with a much
larger mafs of flefh.
And the other ufeful inference is, that if any thing of this kind mould,
come from any widow, even long after the death of her hufband, which
comes near to the nature of a true mola, and even is a true mola-, we mult
not immediately doubt of her chaftity : fince, as has been faid above, the
placentula might have remained in the uterus formerly, in an abortion that
had not been much taken notice of.
And though thefe things by no means take place in virgins ; yet even in
them, as I faid, we muft confider again and again with accuracy, and take
care that no deception may happen.
And that this may be avoided as far as poffible -, it will be proper to at-
tend to thofe things, in flefhy excrefcences, and in polypous concretions of
blood, which arc taken notice of above (g), and to read over the places of
Ruyfch that are referr'd to -, and indeed to add the obfervation of the cele-
brated Schlierbachius (b), who -, although he faw a mola " in fome meafure
" vafcular, and, at the fame time, fill'd with copious hydatids, that feem'd
Cl interlarded with a great quantity of fat-," did not for this reafon deny that
it came from a virgin -, I fuppofe becaufe even in polypous concretions there
is often an appearance that in fome meafure refembles fat; and we fome-
times fee thofe appearances that referable vefTels : as to hydatids, I fpoke of
them juft now.
(d) Mem. de l'Acad. R. des Sc. a. 1735. (g) N. II.
(<r) Tom. 2. cit. p. 2. t. ult. (£) Aft. n. c. torn. 7. obf. 61.
(/■) Eph. n. c. cent. 6. obf. 74.
Tl.us
Letter XLVIII. Article 14. 711
Thus Phil. Jac. Hartmann alio :'/), did not fuffcr himfclf to be deceiv'd,
either by the appearance M of I rat cuticle," or by " many coats intcrmix'd
M with fibres, and refills, ot" a white colour •," or, finally, by •* a veficlc
" inherent internally, and containing a jelly •" but acknowlcdg'd it to be no-
thing more than M a coagulum or blood :" notwithllanding it was in a wo-
man, in regard to whom, it' he had laid that it was a true mola, he would,
from thence, have brought no reproach upon her honeft lame ; as (he was
a married woman.
We mult therefore inquire, not what appears, but what really is, and that
with accuracy •, for true fibres, true vefiels, true coats, and a bladder made
up of thefe, cannot exift without the interpofition of a man.
Nay, even a bladder of this kind, would be the mod legitimate among all
moire •, as it is the involucrum of the beginning of an embryo, and of the
humour in which the embryo fwims ; if a thing of this kind were compre-
hended under the name of a mola, as it is now understood by molt perfons:
although the feme Hartmann (£), and the celebrated Gotwaldt (/), in imita-
tion of him •, the laft of which authors has illustrated his obfervation by a
figure, very fimilar to thole that were publifh'd afterwards by Ruyfch (m) ;
have call'd this very appearance " a mola veficularis," or bladder-like
mola.
This, therefore, cannot exift in virgins, nor, as far as I know, that in like
manner, which might with more propriety be call'd a " mola veficularis •"
I mean a congeries of veficles difpos'd after the manner of a clufter of
grapes.
And left any deception fhould happen in judging of this, it will not, I be-
lieve, be ufelefs to infpect the moft accurate defcriptions, and reprefenta-
tions by figures, of thole which have been difcharg'd after conception -, and
to attend to the branches, or ramifications therein, to which they have often
hung when difcharg'd.
Defcriptions and figures of this kind, you will not find in fo perfect a ftate in
Ruyfch (») ; although he has reprefented the veficles more than once, and
has mention'd them many times; as in Malpighi (o), and Vallifneri(p).
And certainly, thofe fmall excrefcences which are made up of veficles, and
which I have happen'd to fee within the uterus, • had no appearance of
branches, to which the veficles were hung; but were crouded clofely to each
other, and coher'd either by their own fubftance, or by means of an inter-
pofing fubftance, which was neither flender, nor ramifying.
14. However, there are fo many oblervations publifh'd, of bladders being
ejected from the uterus ; and fo many collections of thofe referr'd to by men
of erudition ; that I fhould feem to be undertaking a very ufelefs labour, if
I fhould add, at large, any others that have come to my knowledge.
For I know that a matron of Forli, about forty years ago, difchafg'd vefi-
cles, fome of which were larger, others fmaller, and fome very fmall ; and
that here likewife, the wife of one of the governor's fervants difcharg'd, in
(/) Eph. n. c. dec. 3. a. 5 & 6. obf. 206. (*) Adverf. Anat. dec. 2. c. ult.
(&) Earund. dec. 2. a. 10. obf. 157. (0) Op. Pofth.
(/) Earund. dec. 3. a. 9 & 10. obf. 159. (p) Opere loc. cic. & Eph. n. c. cent. 9. obf.
(w) Thef. Anat. 6. tab. z. 73.
the
712 Book III. Of Difeafes of the Belly.
the year 1727, a great number, inftead of a foetus that was expected-, and
that Albertini, about the beginning of the year 1724, had, once and again,
at the diftance of a month, feen a congeries of veficles difcharg'd from a
certain woman (not without fome fever and fevere pains) which refembled
the larger branches of the red currants in their figure and difpofition ; ex-
cept that they were of a colour fomewhat more dilute : nor indeed does the
colour fhow that thofe veficles were different from others which we fpeak of;
fince not only Tulpius(^) has not doubted that fome, which were diftended
with " a yellow water," but Lancifi (r) alfo, that others, which were on one
and the fame branch, among the reft, that were full of a limpid, or yellow-
ifh fluid, and were diftended " with a kind of redifh cruor," belong'd to
this clafs ; nor yet thofe celebrated men Magnenius (s), Dechiappa (t), and
Guttermann (u) •, the latter of whom in fome of the largeft, and the fecond
in all; for they were all pretty large-, faw " a bloody" or " redifh fpot"
internally: but Magnenius, in another mola, faw fome " of a yellovvifh co-
" lour ;" and two only or three externally " redifh ;" and in another, of the
fame woman, found all them ; which were innumerable and very fmall ;
" of a very red colour."
To thefe obfervers you will finally add the illuflrious Haller, where (x) ;
defcribing white veficulas, which adhered to ftalks going out from the pla-
centa •, he fays that in the placenta itfelf alfo, " there had been more red
" veficles, which were connected to each other in the fame manner."
I omit others, in which nothing is remark'd that has any reference to a red
colour ; whether the bladders have been difcharg'd from the uterus, in a
loofe and unconnected ftate •, as thofe probably were, that are mention'd in
the Commercium .Litterarium in the year 1745 (jy)j and certainly, if I am
not miftaken, thofe that are taken notice of by the celebrated Phil. Conrad.
Fabricius (z) ; or not in this free and unconnected ftate, but difpos'd in a
confus'd order ; as thofe which are defcrib'd by the celebrated Wogan (a) ;
or, at length, whether they are " collected like clufters of grapes ;" as thofe
which were feen by the celebrated men Jo. Sebaft. Albracht (b)y and Jo. Jac.
Treyling(0: t0 which clafs almoftall thofe belong'd that I fpoke of juft now.
A great number of the fame kind have alfo been brought to me fome-
times-, efpecially, in the year 1716, thofe which a woman of Verona had
difcharg'd, after the exclufion of a foetus, by a violent abortion.
Thefe I examin'd together with him that had lent them, Vallifneri. But as
for the fame reafon, I fuppofe, that has been mention'd ; I mean the very
great number of hiftories of that kind already given •, he did not, as far as
I know, publifh this obfervation, I fhall likevvife pafs it over.
I fhall rather add what a kind of incipient mola veficularis, I found in the
uterus of a bitch, in the year 1723 ; for there are not fo many hiftories ex-
(7) Obf. Med. 1. 3. c. 32. (y) Hebd. 33. in fine.
(>) Epift. fupra cic. ad n. 1 1 . qua? prima eft (z) Propempt. ad Dill. I. B. HorFmanni,
apud Vallifner. Ift. della Generaz. p. 3. c. 3. not. c.
(s) Aft. n. c. torn. 1. obf. 166. (a) Eph. n. c. cent. 9 obf. 85.
{/) Ibid. obf. ead. (6) Commerc. Litter, a. 1738. hebd. 2S. n.
fuj Obf. cit. fupra ad n. 9. 1. in fine.
(x) Opufc. Pathol, obf. 40. (t) Act. n. c. torn. 5. obf. 134.
tant,
Letter XLVIII. Article 15. 713
tant, of a mola of this kind feen in the uterus, as when difcharg'd there-
from: and it muft be that mola: are more rare in brute animals, than in wo-
men ; fince not only Ariltotle (d) has laid that they " are either generated in
" women alone, or in women chiefly;" but alio, among the more modern wri-
ters, Harderus (c) denies his " having feen any thing of this kind, that was
" difcharg'd from the uterus of a brute;" and requefts of others, " that it
" they have found any appearances of this kind at any time, they do not
" withold the relation thereof from him and the public."
It does not efcape me, that in the eggs of hens, whether excluded, or
inherent in the ovaria, mola? have been found ; as by Vallilheri f/j, and by
Gotwaldt (g),
And in thofe brute animals that they call perfect, of which Harderus feems
to fpeak, I do not deny, that there may perhaps be examples which are
more clear, in the beginning, than this that I am about to produce : at pre-
fent however, I do not remember to have read them : and although a very
learned man fays, " that Vallifncri had defcrib'd a mola veficularis, even in
" a cow ;" he perhaps meant to fay in a bitch, in which animal he did really
defcribe (b) one ; but one of fuch a kind that he himfelf has confefs'd it
*' difficult to judge, whether it was not fome preternatural production from
" the fubftance of the uterus."
15. A little bitch which had brought forth young feveral times, but not
more than two at each birth ; having, a month before, copulated with a dog,
was fuppos'd to have become impregnated : at laft having feem'd to be fad,
and melancholy, for fome days, (he was fuddenly feiz'd with convulfive mo-
tions, and died without any howling. The mailer of the bitch ; who was a
learned man, and an intimate friend of mine ; came to me on the day follow-
ing, and beg'd of me, that if it was convenient I would inquire into the
caufe of the creature's death : which I immediately did, in the prelence of
him, who had order'd the carcafe to be brought, and others who were fkill'd
in difTedtion.
The lateral ventricles of the brain, and efpecially the left, contain'd a great
quantity of water ; which the rednefs of the choroid plexufies fhow'd to have
been effus'd there not long before death.
The cavities of the heart were full of blood almoft coagulated, and very
black.
The membranes of the belly in particular ; for they were fat in other
places ; were loaded with fo great a quantity of fat, and chiefly about
the uterus, that I could not demonftrate the whole (lender tract of both
tubes.
The teftes, although near to one of them hydatids were feen, had no ve-
ficle fuch as they generally have in a natural ftate : nor was it to be wonder'd
at, fince the whole of them feem'd to be in a manner flefhy : that is to fay,
from the bodies which we call corpora lutea, in cows and in women, being
contracted.
(</) De Generat. Animal. 1. 4. c. 7. (g) Eph. n. c. dec. 3. a. 9 & 10. obf. 157.
(e) Eph. n. c. dec. 2. a. 2. obf. 185. (b) Opere torn. 2. p. 2. verf. finem.
(f) Opere torn. 1. p. 3. pag. 126. & torn.
2. p. 212. n. 16. & pag. 240. a. 9.
Vol. II. 4 Y Yet
714 Book III. Of Difeafes of the Belly.
Yet the cornua were both of them tortuous in their paflage : and in feveral
places more or lefs protuberant •, although not lb much dilated into diftincl:
cells in any part as I have been us'd to fee in bitches, that had been preg-
nant for fome time.
The whole internal furface thereof was tender to the touch, and red.
But in thofe places where larger protuberances, than the reft, appear'd ex-
ternally, a thick humour was contain'd, of a mucous nature, and of a white
colour mix'd with green •, fo as to refemble pus •, being inodorous, and mow-
ing no primordia of the fcetus.
This humour was furrounded by a kind of foft and redifli fubftance, where-
in veficlesfull of water difcover'd themfelves-, thefe veficles being of a different
magnitude, but all fmall in their fize, and not very numerous in their
quantity.
16. Among the other caufes of falfe pregnancy, I fee that, in the Sepulchre-
turn, after molae, other tumours of the uterus are with propriety reckon'd ;
and not only of the uterus, but of fome other parts of the belly alfo.
Of the uterus, whether they be from internal or external excrefcences, or
from humours in the parietes of that vifcus •, or even ftagnating in the ca-
vity thereof; when the paffage of the ofculum outwards is ihut up by any
caufe that either conftringes, or obftrutts, it. And of fome other vifcera,
and of the mefentery in particular. Upon all which ill bj eels as I have in ge-
neral written more, or lei's, on former occafions ; it is not neceffary to repeat
the fame here.
But I will rather difpatch that queftion, which I remember you afk'd of me ;
I mean when, and how, by reafon of one kidney only being created in fuch
a manner, from the firft original of the body, the belly may be prominent,
fo that even an anatomift may be deceiv'd -, and take this prominence for an
utero-geftation ? For that this has been advane'd, among the other caufes
" which refemble pregnancy," in this fedlion of the Sepulchretum (*)..
Although I forefee, that I muft enter into fo much more prolix a difcourfe
than you imagine, that I may feem, to you, to have digrefs'd from the inten-
tion of this letter ; yet I fhall do it willingly : and that not only becaufe if I
mifs this opportunity, I fhall have no other proper occafion offatisfying your
requeft, but becaufe I fhall endeavour to reduce into fome order, almoft in-
numerable obfervations of the kidney alone ; which reduction I fhall endea-
vour, to make as ufeful as poffible.
But it would certainly have been much more eafy for me to have fatisfy'd
you now, if thofe who collected examples, after Pinus (**), of one kidney
alone being found, Schenk (i), Bauhin (k), Riolanus (7), Panarolus (m)y
Rhodius («), Hornius (0), Blafius (p), Francus (q), Hilicherus (r), and others
after them, had, every one of them, given thofe that were already publiih'd
(*) XXXVII. Vid tkulum. obf. 3. prefix. (/) Anthropogr. 1. 2. c. 26.
ad n. 6. qui pro n. 7. ibid, ponitur. («i) JatrologiTm. Pentec. 1. obf. 3.
(**) Annot. ad pag. 51. 8. Opufc. Anat. (n) Mantiff. Anat. obf. 32.
Euftach. (0) Annot. g. ad Botalli. obf. anat.
(/') Obf. Med. Rar. I. 3. ubi de Renib. obf. (/>) Append. adBellin. de Renibus.
2 & 3. \q) Eph. n. c. dec. 3. a. 5 & 6. obf. 176.
(&) la Notulis ad Theatr. Anat. 1. 1. c. 22. (r) Proluf. de unico reperto Rene.
in
Letter XLVIII. Article 16. 715
in their times-, as they might eafily have done j and had diftributed them into
certain dalles.
But they have omitted fome even in books that are in every one's hands :
and thole they have produe'd, they have generally made a practice of pointing
out almolt promifcuoully ; whereas it would not have been difficult to divide
them into thole wherein one kidney only was form'd; and into thole where one
kidney, to appearance, was made up of two •, and the firft of thefe again,
into thofe wherein the kidney occupies the fide as ufual •, and into thofe
wherein, being laid upon the ipine, it holds a middle fituation.
To thofe firft, wherein the kidney lies on the fide ; befides the antient
examples from Ariftotle (s) , belong thofe which fo many after him, and
among thefe Sphasrerius (7), and Solenander(w), from Mat.Stoicus, Plazzonus,
(x), with Sylvaticus, in whom it will be better to read them, Haller (j), and
Petfchius (2) have propos'd -, and if you choofe rather to fet afide, on this oc-
cafion, my doubt that has been hinted in the fortieth letter (a), even Tul-
pius (b), and Meekrenius (c).
Which doubt you may let afide in the obfervation of Hilfcherus (d) : al-
though this may be added, by you, to thofe that are in the Sepulchretum,
on the fubjec~V. of renal ifchuria?, from calculi ; yet to omit other things, fuf-
ficient teftimonies are collected by the ingenious inquirer, to convince us that
one kidney had been wanting from the original formation : juft as it was in
that profeflbr of Cabrolius (f), and in the young man of Manfredi, the little
bitch of mine, and the rabbet, all of which were taken notice of by me on
former occafions (f) ; and even in the prieft, and the woman of Valfalva, and
the girl of Pouparr.
And there was this proof alfo, in that woman, of there having been but
one kidney from the original formation; I mean that the kidney was furnifh'd
with two pelves, and two ureters : and we not only read that there was the
fame number in the young man of Panarolus (g), and in the foldier of Lau-
bius (b) ; but befides, that one of the ureters had inferted itfelf into that part
of the bladder, to which no kidney correfponded.
To the examples hitherto mention'd, all of which belong to the firft clafs, it
is probable that many others may be added •, either fuch as do not occur to
me at prelent (for I never take upon me to imagine that I have either read
or remember'd all) or fuch as the writers themfelves have fo exprefs'd, as to
fay that there was one kidney only •, as Columbus (i)y Fernelius (k), Cafpar
Wolphius (/), Laurentius (»?), Bofcus (»), and Jo. Scultetus (0) ; who points
out both his father's obfervation and his own , and Salzmann (p) : and out
(f) Apud Schenck. obf. cit. 2. (f) Adverf. Anat. 3. Animad. 32. & Epift.
(t) Ibid. 40. n. 14.
(u) Ibid. obf. 3. (g) Obf. 3. cit.
(x) Apud Rhod. cit. obf. 32. (b) Eph. n. c. cent. 9. obf. 16.
(y) Opufc. Pathol, obf. 60. (/) De Re Anat. 1. 15.
(ssj Syllog. Anat. Seleft. obf. §. 77. 78. (k) Phyfiol. 1. i.e. 7.
(a) N. 14. (/) Apud Schenck. obf. cit. 2.
(/>) L. 4. obf. med. c. 38. (m) Hift. Anat. Hum. Corp. 1. 6. c. 23.
(<:) Obf. Med. Chir. c. 40. («) De Facultat. Anat. left. 2.
(d) Proluf. cit. (0) Trichiaf. Admir. pag. 89.
(e) Obf. var. 14. (/) Apud Stehelin. in Tentam. Med.Th. 1.
4Y2 of
716 Book III. Of Difeafes of the Belly.
of the obfervers who are quoted by thofe very learned men, Rhodius (j), and
Haller (r) ; Lopez, Ronfeus, Duretus, Handwigius, and Humelius ; fome
have perhaps given examples that belong to this clafs : I fay " perhaps" for
this reafon, becaufe fome of the books referr'd to are not in my hands ; and
others, as far as I could inquire, do not contain thofe' things that are fpoken
of; jurt as I tnrn'd over the Commentaries of Carpus on Mundinus in vain ;
for that " other example," as Riolanus (s) fays, I did not find where it princi-
pally ought to have been.
And although mod of thefe authors, of both clafles, have faid, that this
one kidney was large; and even fome of them, as Columbus, that it was
" very large •, as Fernelius, " of a fuprizing bulk and magnitude ;" as Bof-
cus " of an almoft incredible magnitude and breadth;" you are not immedi-
ately, for this reafon, to fuppofe that they have fpoken of the kidney, which
did not belong; to the firft divifion of the firft clafs.
For you very well remember, how much either of the kidnies may
grow out (/) : why then may not the kidney, when there is only one, be
large in the fide? It may even be very large, if the effec"l of adifeafe happen
to be added ; and calculi, pus, and urine, are retain'd fo as to diftend its
fubftance, as is the cafe in more than one of the examples produc'd above.
However, do not imagine, that, in faying thefe things, I approve of what
has been afferted by a learned man ; that when there was only one kidney,
" it had always much exceeded the natural magnitude of the kidney, by the
" teftimony of all obfervations."
For I do not fee this remark'd in all the obfervations : and, indeed, I fee
that Panarolus (u) exprefsly admonifhes us, " that it had not exceeded its
" proper proportion" in his ; and Valfalva (x), in one of his, that it was
" of its natural magnitude."
Wherefore, Riolanus (y) was lefs wide from truth, when he afferted that
" if one folitary kidney be found, it generally equals the magnitude of
" both." I wifh I could approve of what he immediately adds, " and that
" it lies upon the back ; the canals of the aorta, and vena cava, being a little
" remov'd, in order to afford a fituation for the folitary kidney."
But what a number of examples there are, of a folitary kidney retaining
its ufual fituation, is evident from what has been faid above. And as to its
lying upon the back, and removing'the large veffels (which circumftance has
not always been obferv'd even then) if all the obfervers of a folitary kidney
had, in general, feen thefe appearances ; they would, without doubt, have
noted them down, as not lefs rare to themfelves, than the unity of the kid-
ney which they faw at the fame time : but as this has not been done, by thofe
who have taken notice of nothing elfe but the folitary flate of the kidney, I
have therefore faid above, that it is probable their obfervations related to the
firft part of the firft clafs, and not to the fecond ; which, though it is much
more rare, Riolanus fuppos'd to be the only one: as if it contain'd all the
examples of a folitary kidney.
(?) Obf. 32. cit. (/) Vid. Epift. 40. n. 14.
(r) In Acceff. ad Boerh. Meth. Stud. Med. («) Obf. 3. cit.
p. 7. feft. 4. c. 14. (*) Epift. 25. n. 4.
Is) C. 26. cit. (y) Encheir. Anat. 1. 2. c. 28.
But
Letter XLVIII. Article iO. yiy
But before I (peak of this part, it will be more convenient to difoatch the
fecond clafs ; to which I refer r'd not lb much the kidney made initcad of
two, as made of two.
And this I would have you underftand, not as if I denied, ih.it, in fotnc
of the examples produe'd above, one kidney feem'd to be made up of two ;
lb that it was iurniih'd both with a double pelvis, and double ureter; or
as if I contended, that, of two kidnies, which were firft created in a ftate of
diftance, and divifion, one had afterwards coalefc'd with the other, upon the
increale of the em brio.
For I mean nothing elfe here, but what appears to the firft judgment of
the fight. Jacobus Berengarius (z) law this the firft, as far as 1 remember.
In a certain man, fays he, " the kidnies were continued into each other, as
01 if it had been one kidney : and it had two emulgent arteries, two emulgent
'• veins, and two ureters, with only one involving panniculus : this occupied
M the ufual places of the kidnies, and even the middle of the back, which
" is in the part betwixt the fplecn and the liver, a little below them."
And to the fame clafs belongs that folitary kidney feen by Rondelet (a),
" which was of the fhape of a moon ; both the kidnies, without doubt, be-
" ing in conjunction-," and that which Blafius {b) fpeaks of from Doldius ;
and that which Riolanus (c) defcribes as being found by him and " plac'd
" above the fpine the cone being inclin'd downwards, and the horns
" rais'd upwards."
Nor do I fuppofe that feen by Piccolhominus (d) to be of a different kind ;
except that the conjunction was made betwixt the fuperior parts of the kid-
nies ; as, when " it lay tranfverfly upon the vena cava, and the great artery,
" its flat and finuous furface was turn'd downwards, but the gibbous and
" convex furface turn'd upwards ;" fuch as in figure and pofition, the illui-
trious Winflow (e) faw in a monfter.
In the other examples, the horns were turn'd upwards, as in .the former
inftances ; and in thole of Thomas Bartholin (f)t and Stalpart (g) ; who alfo
faw fomething fimilar with Nuck (h) ; the celebrated Haller (i), Vernoius (£),
and Petfchius (I), to fay no more of Graffeckius and Bacchius, than what I
know from Haller (»;) ; I mean, that one of them " had feen a kidney made
" by a coalition of two," and that the other " had mention'd a kidney con-
" filling of the two grown together, from the original formation :" and to
return to the Italians ; Jo. Orontio Azzaritti, a native of la Puglia, for-
merly my pupil, fent to me, in the year 1721, a defcription, and delineation,
of a folitary kidney ; on which he had lit in difTecYing a human body at Ve-
nice, and which may be compar'd with that of Bartholin, whereto it was very
fimilar: for befides other things, I believe it may (how from whence the fper-
matic arteries, which Bartholin has faid did not exift at all, might arife.
(s) Ifag. de Anat. Ventr. Inf. ubi de Re- (g) Cent. 1. Obf. Rar. Med. 50.
nib. (h) Ibid.
(a) Apud Schenck. obf. cit. 2. (i) Opufc. Anat. p. 5. tab. 6. fig. 9.
\b) Cit. Append, fig. 13. {k) Comment. Acad. Sc. Imper. Petropol".
(c) Anthrop. c. cit. 26. torn. 3.
(J) L. 2. Praeleft. Anat. 22. (/) Syllog. cit. §. 79.
(e) Mem. de 1'Acad. R. des Sc. a. 1740. \m) Acceflion. ad cU. c. 14. Meth. Stad.
(f) Cent. 2. Hift. Anat. 7-. Med.
And
71 8 Book III. Of Difeafes of the Belly.
And in the year 1732, Bonazoli (») ; who was, while living, my friend,
and whom I have fpoken in commendation of on former occafions alfo •, de-
fcrib'd a kidney of the fame kind.
Finally, I myfelf in the y'ear 1740, found, about the middle of December,
in a girl of fix years oid, and demonftrated in the hofpital, to all who were
prefcnt; both men auvanc'd in knowledge, and ftudents ; a folitary kidney:
which you may fee not inaccurately trac'd out, and drawn at my houfe, and
differing from moil others in this circumftance, in particular, that the right
lobe was diftant from the left by no very great interval •, the former being
laid upon the latter in the lower part, and divided with a fulcus as it were,
which was not very deep however, and only on its anterior furface : fo that
an ilthmus was form'd, which was not lefs flender than either lobe.
Francus (0) is the only one, as far as I know, who faw, and gave a deli-
neation of, an ifthmus " of very great vaftnefs and amplitude" as his exprefs
words are.
But as he fays nothing of the thicknefs, and even fays that each lobe was
in that fituation the kidnies are wont to occupy •, as I underftand it to have
been in the obfervations of others, in which, although the whole kidney was
very large, it, neverthelefs, lay upon the fpine only with a very (lender ifth-
mus •, I was not willing to confound thefe examples, with thofe that belong
to the fecond part of my divifion, to which I now pafs on •, and which-com-
prehends thofe examples, wherein the whole body of the kidney was laid upon
the fpine.
And to this part of the divifion I mall fuppofe that to belong, which Caro-
lus Stephanus (p) faw, together with Jo. Vaffeus •, that is to fay, " one kid-
" ney alone, fituated exa&ly on the middle of the fpine •, and this very large:"
and we may likewife add what Andernacus had faid (q), " that fometimes
" one kidney only appear'd to be connected to the middle of the fpine."
And that which is defcrib'd, and reprefented in a plate, by Botallus (r),
and was fo large as to feem to be made up of four, is extremely well
known.
Nor is that unknown, which Cabrolius (s) found, in the fervant of the
profeffor, who has been mention'd •, " a folitary kidney, but of an in-
" credible bulk, lying upon the vertebras of the loins :" to which the cele-
brated Fantonus (t)> in like manner, faw " a folitary, and very large, kid-
" ney, adhereing."
To the fame clafs you will refer that which the frequently-commended Hal-
ler («) found in a girl of a year old.
And to return to the more ancient writers, and, at the fame time, to come
nearer to that point, for the fake of which I enter'd into this long difcourfe ;
Vefalius (x) had written, that fometimes, in thofe who " have the belly ex-
" ceedingly prominent, and the order of the ribs vitiated, he had feen a foli-
(«) Comment, de Bonon. Sc. Acad. torn. 2. (r) Obf. Anat. 1.
p. 1. (s) Obf. cit. 14.
(0) Obf. cit. 176. \t) Diflert. Anat. Renov. 7.
(p) De Diffeft. Part. Corp. Hum. 1. 2. (a) Opufc. Pathol, obf. 59.
c. 15. (x) De Corp. Hum. Fabr. 1. 5. c. 10.
(q) Anat. Inftit. 1. 1.
2 " tary,
Letter XLVIII. Article 16. 719
" tary kidney •, and that a very large one ; plac'd upon the vena cava, and
" the large artery."
Euftachius (y) has aflertcd, that he had formerly once feen an unufual
fituation of a Iblitary kidney of this kind •, but " that he remember'd only
" this circumftance very well ; that it lay fupported on the middle of the
" fpine, and fupplied the deficiency of the other kidney by the increafe of its
" own bulk :" and he lubjoin'd the following words : " but whether nature
44 has given one kidney alone, to thole, in particular, who have the belly very
" prominent, and the order of the ribs vitiated, I confefs I am ignorant :
*' and I exhort thofe who ftudy anatomy, to obferve, with diligence, whe-
" ther this be true or not."
From that time I do not remember to have read any author, who attend-
ed to this exhortation of Euftachius, when he lit on a large kidney lying on
the fpine ; nor yet when he found the ifthmus of two lobes lying tranfverfly
thereto.
And even in both cafes, I have either found nothing remark'd in the ex-
amples hitherto produc'd; or only, that the man being in very good health,
he was taken off by the fword, the halter, or a malignant fever ; if you
except the obiervations of Piccolhominus and Azzaritti : the former of
whom has hinted, that there was a bad conftitution of body •, perhaps from
the ifthmus prefilng upon the vena cava and great artery, and, for that rea-
fon, injuring the function of both ; and the latter accounted for an aneurifm
of that artery, from the fame caufe ; that is an aneurifm which had arifen be-
twixt the appendages of the diaphragm, eroded the vertebra?, and at length
put an end to life, by pouring out a great quantity of blood into the left
cavity of the thorax.
The ifthmus however, for the moft part, being but {lender, unlefs it hap-
pen to grow thick gradually, or the blood, being immoderately increas'd
in its quantity, diftend the fubje&ed large veffels, does not generally do fo
much harm.
I, when in the body of a girl, I found an ifthmus not lefs flender than
either lobe •, as I have already faid ; and the lobes not very far diftant from
each other; as they did not occupy the ufual feats of the kidnies; but lay
upon the very fides of the vertebrae ; did not think that I ought to neglect
the exhortation of Euftachius.
However, the abdomen of the girl was not prominent •, nor did the courfe
of the ribs vary from its ufual order ; fo that if any perfon fliould have been
willino-, with Vefalius, to deduce the caufe of the lobes having been ex-
eluded from their fituation by the unufual flexure of the ribs forwards ; it
would have been quite out of his power.
Nevcrthelefs, that the belly was, in this cafe, but little prominent, was lefs
to be wonder'd at here \ as the whole kidney was neither one of the largeft, nor
had any confiderable part of itfelf laid upon the anterior part of the vertebrae.
But I can fcarcely believe, that, when a very great bulk of one folitary kid-
ney is fuperadded to this part, which is of itlelf lb prominent, the belly is
not prominent.
(y) De Renibus c. >o.
And
720 Book III. Of Difeafes of the Belly.
And indeed I read that our Plazzonus (z) " had fuppos'd" that woman,
in whom there was a folitary kidney, " to be pregnant at firil •," that is be-
fore he open'd the abdomen : and I fuppofe that our Spigelius would have
thought, or rather fufpected, the fame thing alfo ; if it had been a woman,
inftcad of a man, in whom (a) " he found a kidney very fimilar to that wo-
man's kidney."
And now you, of yourfelf, plainly fee, although what I faid when I was
fpeaking of Plazzonus, is related in this very thirty-ieventh fection of the
Sepulchretum (b)> among the examples of falfe pregnancy ; that it is not to
be underftood as being extended any farther than to the fufpicion of the ana-
tomift, who is about to di fleet the body. For while the woman is living,
and interrogated upon the point, the tumour cannot impofe upon us for a
pregnancy, which did not begin a few months before ; but exifted quite
from the original formation.
But we may be impos'd upon, by one or other of the kidneys being grown
very large from difeafe ; not naturally ; and fallen down into the hypoera-
ftrium.
Thus, in a matron of whom you will read in the hiftory of the Royal Aca-
demy of Sciences at Paris (c), it might have been taken for a pregnancy of
the uterus, which had been of three or four months (landing; efpecially as
the menftrua were obstructed ; if the age of the woman, her health, and fome
other things, that follow'd, had not caus'd a different perfuafion.
Thus far of falfe pregnancy.
17. It comes in courfe now, to fpeak of abortion ; but of this only with
brevity. For I have already produe'd three obfervations thereof above (i),
when I was fpeaking of true pregnancy being miftaken for the falfe : and it
were almoft endlefs to recount all the caufes of this diforder •, whether they
exift in the fcetus, or the fecundines, or have their origin from the difeafes of
the mother.
Examples of many of thefe latter, that pafs from the mother into the
fcetus, are collected by Frederic Hoffmann; in that diflertation, which, altho'
it is, in general, intitled " of the diforders of the fcetus in the uterus of its
" mother," turns, neverthelefs, for the moft part, upon thofe that are com-
municated by the mother.
We, on the contrary, will fpeak of thofe former ones ; and yet not of all.
But as 1 have written above of fome of the diforders of the placenta ; I will
now touch upon fome that are either caufes of abortion ; or make that abor-
tion dangerous.
That the placenta, when thicken'd and become hard, may be the caufe of
abortion, I do not doubt •, for at firft, by its increas'd bulk, it renders the
the fpace of the uterus too narrow for the fcetus ; as has alfo been obferv'd
by Cortefius (<?), where he taught that the placenta " fometimes becomes
" very thick and hard." And the hardnefs renders it unfit for its office ;
wherefore the fcetus, being depriv'd of its nourishment, perifhes ; which A-
braham Vater (f) confirms by the obfervation of a fcirrhous placenta.
(z) Apud Rhod. obf. cit. 32. (</) N. 5. 7. 9.
(a) Ibid. (<?) Mifcellan. Medic, dec. 9. epift. 3.
(A) Obf. 3. §.7. (/) Difl". fupra ad. n. II. cit. thef. 10.
(<-) A. 1732. obf. Anat. 7.
The
Letter XLVIIL Article 18, ig. 721
The feme author thinks, that, when the foetus is dead, if the placenta re-
main in the uterus, and lix'd thereto, it may itfelf receive the nourishment
from the uterus, and by this means become Ct ill thicker than it was before :
nor is he the only one who entertains this opinion.
Hut there is, on the other hand, a cafe, in which, by reafon of the intercep-
tion of the nutriment, both the placenta, and rectus, are extenuated in a fur-
prizing degree : and although this appears, in part, from the obfervationr,
of thole very celebrated men Hoyerus (g)t Moekringius (£), of a foetus be-
ing dilcharg'd " in a very emaciated tlate, and with its bulk exceedingly
" diminifh'd," after great dilcharges of blood from the uterus ; the funicu-
lus umbilicalis, at the fame time, being almoft deftitute of moifture," or
" the placenta fmall and almoft juiceleis, and furnifh'd with little blood -y
" as their own words are ;" yet this is more clearly fhown, by the hiftory
which was communicated to me, by a phyfician who was my friend.
18. A certain woman was now in the fourth month of her pregnancy, and
juft entering upon the fifth, when news was fuddenly brought to her of the
inltant death of her abfent hufband. Being {truck with grief and fear at the
fame moment, fhe, from that very time, at firft obferv'd the motion of the
foetus to be made more languid ; and after that to ceale intirely. And at
the end of the eighth day after fhe ceas'd to feel the child's motion, flie mif-
carried.
The placenta, the dead foetus, and the funiculus umbilicalis were all fur-
prizingly thin and (lender. The foetus was quite white: and in the funiculus
was fome appearance of vefTels, but thefe were almoft deftitute of moifturc.
19. That abortion, which is produe'd by other caufes alio, often returns ;
and this at the fame interval of time, from conception, that the former had
happen'd ; as, for inftance, at the fourth, third, or fecond month, from that
time ; and yet that its return has been prevented by proper remedies, you
-will learn from Stahl (/').
I, however, remember none to have return'd more frequently, than that,
which •, being firft brought on by a great, and fudden, affection of the mind,
as I have read in Schulzius (k) ; return'd three and twenty times, always at
the fame diftance of time from conception at which it had firft happen'd ;
that is at the third month •, notwithftanding no remedies, that could be fup-
pos'd, by the moft celebrated phyficians, to have effect in preventing it, were
neglected.
You fee then, what power paffions of this kind have, in producing thefe
effects.
But in the cafe propos'd by me, I fhould believe it had happen'd to the
uterus, and confequently to the radicles of the placenta, that thofe fluids
which were carried back from the foetus, and the placenta, to the mother,
pafs'd on with eafe ; but that thofe which were carried from the mother, to
the placenta and foetus, were not carried without difficulty ; as the mother,
being lb affected in her mind, could neither fend fufficient nourifhmenr,
(_§•) Eph. n. c. cent. i. obf. 51. (k) Difput. q.ia corp. hum. momentan. aY-
(V) Comerc Litter, a. 1736. hebd. 21. n. 3. terat. fpecim. expend. §. 34.
{/') DiiTert. de Abortu, c. 1.
Vol. II. 4 Z nor
722 Book III. Of Difeafes of the Belly.
nor nourifhment fufficiently prepar'd, nor driven towards the uterus with
Sufficient force, at the time when it was necefiary, according to the ufual
courfe of nature, that every thing in the uterus mould be more and more in-
creas'd every day.
There has been, on the other hand, when I fufpe£ted, that the extreme
tubuli of the little placenta, together with the uterus of the mother, being
contracted by the fudden cold of death, the blood was obftru&ed in its re-
turn from fcetufles, that were, in other refpefts, very healthy •, and this blood
being collected together in the liver-, which was then greatly diftended and
tender-, had made an impetus thereon, and burfl forth into the cavity of the
belly.
I will here add the obfervations : you will explain them as you pleafe.
20. A cow had been pregnant with a foetus for a little time only, as will
appear prefently, when fne was fold by her matter who was ignorant of this,
and kill'd.
The uterus, and the foetus, I differed with care -, the latter not being
longer than a fpan, from the upper part of the head, to the beginning of the
tail. Every thing was in a natural flate -, except that blood was extravafated
and coagulated about the liver : and that in a confiderable quantity too.
21. Another cow was likewife advanc'd two months in her pregnancy,
when ihe was kill'd by the butcher.
Upon cutting open the uterus, and examining whatever was contain'd
therein, I found all to be found -, except that the belly of the foetus was dif-
tended with fuch a quantity of extravafated blood, that before I open'd it, I
conje6tur'd what would be the appearance, from the blacknefs that was ieen
through the extenuated abdomen : and the very tender ftate of the liver, to-
gether with a laceration which it had at one part, plainly fhow'd from whence
this blood had been difcharg'd.
22. But whether the fame thing happens in fcetufles more advanced, I do
not know.
Certain it is that thofe injuries, which, I have faid above (/), come to the
fcetus, from the hardnefs of the placenta, are obferv'd only in the firft
months of utero-geftation.
And that fcetufles, which are now ftrong, and approaching to the time of
birth, mould perifh for that reafon ; thofe in particular, who do not doubt
but a great quantity of aliment is then taken in by the mouth, will not eafily
believe ; unlefs the placenta mould happen to be made univerfally hard, or
otherwife unfit for its office.
For I think there is no reafon to doubt, that the fame caufe, from whence I
have feen it vitiated in any part more than once, may give occafion to a much
greater part being vitiated. What I have feen the fubjoin'd obfervations will
mow.
23. A fcetus that was mature for the birth-, whofe motion the mother
had perceiv'd two days before, but fince that had not perceiv'd -, was born
dead.
The fecundines, together with the fcetus, were brought to me about the
beginning of June in the year 1731. In them I found this one thing which
was preternatural.
(0 N. 17.
When
Letter XL VI II. Article 24, 25. 723
When I infbe&ed the hollow furfaceofthe placenta, within the fubftance
of it, at the uiilance of two inches from the inlertion of the funiculus, I lav.,
through the upper part of its fubftancc, a body of a yellowifh colour mix'd
with white. And cutting into this, I law it compacted of thick membranes
as it were, fome of which were lying upon the others.
As this body was not larger than the laft joint of my little finger, there
did not feem fufticient reafon, why I mould impute the death of the fcetus
thereto •, or even that foftnefs which I obferv'd in mod of the vifcera, to fuch
a decree, that not only the liver became fluid at the very touch ; but the
coat of the kidnies alfo being incis'd, the fubftancc thereof was effus'd under
the appearance of a red pultice.
24. Twins, that were equally healthy and lively, were born at the proper
time of delivery, in the beginning of June likewife, but in the year 1742.
In examining the fecundines (which our Mediavia had taken care to have
brought to me) with accuracy, I obferv'd other things that do not relate to the
preient fubject ; and the following that do. One of the placenta; (for eacli
fcetus had been furnim'd with one, and what happens more rarely they were
entirely disjoin'd from each other-, and not only the claudrum of the mem-
branes was in like manner perfectly divided, as ufual, by a membranous
mediaftinum) one of the placentae then, not far from the edge of it, had a
body, of the diameter of my thumb, going from the convex to the concave
furface; fo that it might be equally feen from both furfaces.
The whole of this body confided of a white fubitance, every where fimilar
to itfelf, and not more hard than the placenta •, and in the other placenta,
alfo, was a body confiding of the fame white fubdance •> but only on its con-
vex furface, and not larger than a fmall vetch.
25. However both of thefe twins were equally healthy, as I have already
faid ; fo that you would not, certainly, conceive the lead injury to have hap-
pen'd to them even by the large white body.
Let us fuppofe that thefe twins had been oblig'd to remain longer in the
uterus •, and yet whether it was pofllble then, that thefe bodies might have
been inlarg'd, or have degenerated into that ftructure, which I have defcrib'd
in the placenta of that other foetus-, and, in like manner, whether it was the
fame kind of diforder ; lefs advane'd here, and more advane'd there -, or a
different one, I confefs I am quite ignorant.
A diforder it certainly was, which if you Ihould choofe to add to that I
made mention of above (m), in deicribing a certain fcetus -, you will confefs
that the placenta is liable to more than one diforder, befides thofe that are->
more known among the common people.
And if this diforder extend itfelf to a confiderable degree ; there feems no
room to doubt, but it may be a caufe of abortion, and of the death of the
fcetus. This is generally the effect of fcirrhous placentae, into which the dis-
orders obferv'd by me, would, perhaps, in courfe of time, have degenerated.
For thofe celebrated men, Jo. Sebad. Albrechtus («), and Jo. Judus
Fickius (0), have feen abortion from thence : both of them of mondrous fcetuf-
(>:) N. 5. (0) Commerc. Litter, a. 1732. hebd. 20.
(. ) Act. n. c. torn. 4. obH 104.
4 Z 2 ItfS,
724 Book III. Of Difeafes of the Belly.
fes, or far lefs than the beginning of ingravidation requir'd ; as Fickius faw
the fubftance of the placenta fo fcirrhous, that it could, by no means, be
now capable of performing its function, and the funiculus umbilicalis corrup-
ted, and in a iranner dried ; and Albrechtus faw fmall tumours lyingatadif-
tance from each other, thro' the placenta, internally of a whitifh colour, very
fimilar to fcirrhous glands-, and betwixt them, about the origin of the funi-
culis, an hydatid full of a yellowifh humour.
At which place, the celebrated Roederer (p) alfo faw a bladder, wherein a
humour of the fame kind was contain'd ; but a much larger bladder, the
fundus of which W2S conftituted by the very fubftance of the placenta itfelf,
and was full of a pretty foft fcirrhus.
But becaufe abortion, as I faid juft now, is alfo accounted for from the
corruption of the funiculus umbilicalis •, we muft not omit to take notice, that
it may alio be deduc'd, either from the too great thicknefs, or thinnefs,
fhortnefs, or length thereof.
An example of the firft, and fecond caufe, you will fee taken notice of by
Ruyich (q) ; who had even reprefented the firfr. in a figure, as " not being
" unfrequent" (r).
And you perceive, that, as too great, or too little, a quantity of fluid being
carried to the embryo, or being carried back from it, may be fatal thereto ;
To the veffels of the funiculus, being either more capacious, or more flender,
than they ought to be, may make the rope either more thick, or more thin
than is natural; nor is that which Ruyfch alone (s), as far as I know, faw, and
that once only, to be confider'd in any other view than that of being very
rare, and wonderful •, I mean that a child was born, healthy, in whofe funi-
culus umbilicalis was a tumour form'd, " hard in its confiftence, and of a
" fubftance partly flefhy, and partly heterogeneous, mix'd with a fmall
" quantity of fluid ;" unlefs, perhaps, it was external in its fituation, fo that
by preffingupcn the veffels it could not make them more flender; or had not
begun to take a fuffkient increafe, before the latter part of utero-geftation.
And when the funiculus is very fhort, being drawn down by the agitations
of the foetus, it makes an impetus upon the placenta; or at leaft does fome
injury thereto; obfervations of which kind are extant in this fection of the
Sepulchretum, that is in the thirty-feventh (t). To which you may add that
propos'd by Littre («), of a funiculus being fo contorted, that it not only be-
came more thin by one half than before, but alfo fhorter by one half.
But one that is very long is liable to be convoluted in the form of a halter,
or to be difpos'd into knots ; fo as to ftrangle the foetus (x), or vehemently
conftringe its own veffels. For the celebrated Gutterman (y) found the vef-
fels obftructed by the force of a double and clofe knot, which could not be
drawn afunder, but with a very flow and cautious hand; making an excellent
conjecture at the fame time, that the firft formation of the knot was indi-
cated by the diminution of motion in the foetus ; and after this more and ft ill
more; and that when, at length, none at all of thefe motions are perceiv'd,
(/>) Differt. de Foetu perf. §. 15. (t) Obf. 1. §. 7. & 9.
(</) Adverf. Anat. dec. 2. n. 10. («) Mem. de l'Acad. R. des Sc. a. 1701.
(V) Thef. 6. tab. 2. fig. 5. & tab. 3. fig. 2. (*) Sepulchr. obf. 1. cit. ^. 8.
(jj Thef. 9. n. 3. (y) Commerc. Litter, a. 1731. fpecim. 20.
we
Letter XLVIII. Article 26, 27. 28. 725
we may gather, from hence, that the cloieft conftriction of the knot is brought
on.
But that the lame fucceffive decreafe of motion, which is finally follow'd by
an abolition, may happen alio in the injury of the placenta, when increas'd
everyday-, as for inihince, by realbn of the fhortnefs of the funiculus, or
from a fcirrhus, or any other diforder which increafes therein more or lefs ;
is not only hinted by realbn, but particularly confirm'd by obfervations, one
of which you will find in the Sepulchretum (z): and others you may colled
from the dilfertation (a) of the celebrated Peter Stuart, who confefies that he
had receiv'd the dogmas advane'd by him, from the mouth of the very cx-
periene'd Friedius (b).
26. Now I will Ipeak (lightly of fome other dilbrders, from whence women,
who mifcarry, are in danger. Ruyfch (c) knew that there were many phy-
iicians, who, being ignorant that in the firft months of utero-geltation, the
placentas are of themielves very fmall; but finding that, by reafon of a great
quantity of blood for the moft part adhering to them* clofely, on every iide,
they feem larger, having feen thefe placentae after being expell'd by milcarry-
ing women, and expelling in vain a foetus correfponding to that placenta in
fize, whereas that which there had really been, had either efcap'd without
being perceiv'd, by reafon of its diminutive fize, or had been difiblv'd into
nothing ; or a kind of fluid; had given medicines to expel the foetus, to the
great detriment of the mother.
He therefore thought that phyficians ought to be admonifh'd of this eafy
deception. And this admonition I think ought to be the more infilled upon by
us, becaufe, befides that blood adhering to the placenta, and increasing ir,
I have hinted above, according to the opinion of Vaterus (d), that the pla-
centa itielf may actually increafe to an unnatural fize; when the little foetus
is already dead, and for that reafon more likely to efcape notice, with great
eafe.
27. But there is another diforder much more dangerous. For, as the pla- -
centa of an immature foetus ; or at lead of one that would not have been
excluded at that time, if no violence had taken place ; is, for the melt parr,
affix'd to the uterus clofely, as four and unripe apples are to their italks •,
it fometimes happens that it is fix'd extremely cloie : and that with the danger
which this obfervation of Valfalva fufficiently demonfhrates.
2S. A woman of three and thirty years of age, having, while pregnant,
once and again lifted a certain heavy weight, from one place to the other •,
fhe brought forth a foetus of feven or eight months : but the fecundines did
not follow. The day after fhe was feiz'd with a fever and rigor : and this
fever growing ftronger and ftronger, a few days after a difficulty of refpira-
tion was added.
In the mean while a foetid matter was difcharg'd from the genitals, with
fome pieces of the fecundines. Finally, convulfive motions, and hiccups,
attack'd the patient : her belly became very tumid : and fhe died on the
eleventh day after delivery.
fzj §. cit. 7. (<■) Thef. Anat. 6. n. 81.
(«) De Secundin. Salutif. & est. c. 2. §. 8. (d) N. 17.
\b) In Proem.
Her
726 Book III. Of Difeafes of the Belly.
1 It belly being open'd, the inteftines and ftomach were found to be f©
full of flatus, that the ftomach occupied lour times as much fpace, as it ge-
nerally does in a natural llate.
Upon opening the uterus, a great portion of the placenta ofFer'd itfelf, to
the view ; part of which hung down through the os uteri : and a part was
lb cloftly affix' d to the uterus, that it could fcarcely be feparated even by the
help of the knife, and this portion was condens'd into a hard and very foetid,
body ; the natural ftructure of it being obfeur'd. And that part of the
uterus, to which it had adher'd, was occupied by a pretty deep inflamma-
tion •, which was alio extended through the remainder of that furface, but
(lightly.
29. Whether you refer this obfervation to the clafs of unfuccefsful births ;
of which I am now to fpeak ; or by reafon of the violent caufe by which the
foetus was difcharg'd, before the full time of its delivery, you refer it to the
clafs of abortions •, it is evident that a part of the placenta, being fix'd to the
uterus, had caus'd the death of this woman.
And this part mult have remain'd fix'd after the feparation of the reft, ei-
ther by reafon of a diforder of the placenta, fixing very thick, very long, or
very numerous, radicles into the uterus at that part ; or, what comes to the
lame thing, by reafon of the diforder of the uterus, which receiv'd thofe ra-
dicles in that place, into moreclofe, more deep, or more frequent pores ; or
from fome other diforder peculiar either to the uterus or placenta; or even
common to both.
But, whatever this diforder might be, which fome other caufe •, that was
the confequen.ee of thofe exertions in carrying a weight, and prov'd by the
acceleration of delivery ; feems to have incieas'd •, at lead this obfervation,
at it increales the number of thofe upon which they ground their reafonings,
who contend that the placenta mould never be left in the uterus ; fo it alfo
gives a handle to the followers of Ruyfch, as three obfervations that you have
in this thirty-eighth feet ion of the Sepulchretum do alfo (e) •, gives a handle I
fay to reply, that at leaft the extraction of the placenta is not to be haften'd,
when it is fo firmly and clofely annex'd to the uterus, that it can fcarcely be
feparated with the knife, as was the cafe m this woman : for that Ruyfch (f)
meant this, when he admonifh'd us that we ought not to be in a hurry to ex-
tract the placenta, if " it adhere fo firmly to the uterus, as no body would
" fuppofe, but he who had experiene'd it-," that is to fay, if " it be at-
'* tach'd to the uterus, as if it had become one fubftance therewith :" nor
indeed did he, and his followers, on the other hand, want obfervations of
very coniiderabie mifchief, and even death, having follow'd the violence
of a hafty extraction.
I confefs, however, I do not take upon me fo far as to fettle thefe contro-
versies, which are of fome Handing, and were agitated among our country-
men, before they were by much later authors •, and carried on to fome con-
fiderable length of time : many writings being publifh'd on both fides (*) •,
•on one hand by Monilia, and on the other by Ramazzini.
(e) Obf. 10. §. 1.2. 3. (*) Dc his vide epift. 8. n. 29.
(f) Adverf. Anat dec. 2. n. ultimo.
■I will
Letter XLVIII. Article 30. 727
I will only fay, that there is great need lure of experience* and prudence,
according to the exigency of the cafe, to prevent us (which is very difficult)
from violating either of the precepts of Celfus (g) : " that it is better to try
" a doubtful remedy than none at all : (h) yet we mull: take care not to let
" this remedy fall under the reproach of having kill'd the patient, whom her
" own fevere fortune had fub.iued."
And indeed, the molt grave and confiderate men are afraid of violence ;
as, after well weighing the arguments on both fides, they agree that there is
no better remedy, either in art or nature, than to wait prudently for fome
little time.
And this I have feen more than once, when the woman lately delivered
has been carried from her chair to bed •, the uterus gradually contracting as
fhe lay quiet and unmolefted, and throwing off the fecundines at the fame
time.
You will read that Hoyerus (i) had feen the fame thing from the mere re-
moval of the woman from one place to another. And if you turn over what
has been lately written, upon this controverly, by that very experiene'd phy-
fician Andreas Pafta (k) ; you will not only fee, that every thing is treated of
with great erudition, and judgment, but in particular will commend his pru-
dent counfels, and admonitions; and this among the reft (/) •, I mean that
the woman be remov'd from the obftetrical chair; wherein fhe is now wearied
and languid, and endeavours in vain to dilcharge the placenta; into bed;
that in a recumbent poflure, the heart and the uterus may be able to do in a
little time, what they could not do in a fitting poflure.
But phyficians are frequently brought into thefe ever terrible dilemmas
that I was fpeakir.g of, by the improper hafte of the midwives; I mean of
thole who, as foon as ever flight pains have arifen, oblige the women to ex-
pel their foetus by too hafty endeavours.
For, nature ciilpofing all things gradually and flowly, for an eafy delivery,
makes the connections of the uterus with the placenta alfo, if time be given,
more pro.^e to feparation ; and even feparates it in the fame manner fhe had
join'd it : but if time is not given ; the quantity of blood that is added round
about altrinces it ftill more.
And with what impetus nature impels the blood, not only to this part at
that time, hut eliewhere, is lufficiently fhown by the example of that worm nr
(»?_), in whom t!' e plexus choroides were ruptur'd, " from a very flrong, and
" untimely, exertion, during the pains of labour;" whereby fo great a
quantity o^ blood was exwavafated, that,' " the brain being comprefs'd into a
M very narrow ipace," a fatal apoplexy was unavoidably brought on.
30. The fame midwives, alfo, delerve great blame, when they are fo
much in a hurry, as, of themfelves, to rupture the membranous fecun-
di.ies, which it is evident ought not to be done, unlefs fome neceflity obliges
them ; as, for in fiance, if they are of fuch a thicknefs or hardnefs, as to de-
Cg) De Medicina 1. 2. c. 10. (/) N. 185.
(.'-) J bid. 1- 5. c. 26. n. 1. (z/j) Aft. n. c. ton, 1. obf. 24!.
(i) Epfe. n. c. cent. 1. obf. 51.
(..) Rr.^ionamento aggiunto al Difc. int. al
fluilo di fangue & ca;t. confider. 13.
4 *aB
728 Book III. Of Difeafes of the Belly.
lay, for a confiderable time, and not without danger, the birth which would
otherwife have already naturally come on.
For frequently, by an untimely effufion of the waters, the birth, for many
reafons, from an eafy and natural one, becomes difficult.
What ? when, of a difficult labour, they make a fatal one, and the birth
impoffible •, as when the pafiages not being fufficiently dilated, either becaufe
it is the firft time the woman has been in labour, and fhe is pretty far ad-
vane'd in life, or becaufe the circumference of the pelvis is pretty narrow, or
fome tumour is the caufe of obfrruction ; or when the foetus not being pro-
perly turn'd for its own exit, they" oblige the woman to exert herfelf, and
itrain exceffively •, or make no fcruple to give fuch things as they have heard
do ftrongly expel the foetus, by exciting the uterus to more vehement con-
tractions; or at leaft by exciting the blood andfpirits.
From whence nothing can more eafily happen, than, as on one hand the
foetus is ftrong, and robuft-, and on the other the mother exerts herfelf with
all her power-, as the foetus cannot be propell'd through the natural pafiage ;
that the uterus is at length ruptur'd, and affords it an opening by which it
makes its way into the cavity of the belly •, either with its head its feet or its
whole body ; and kills itfeif and its mother.
I wifh this cafe of the uterus being ruptur'd was very rare : for it is not
only not rare, but more frequent than many imagine. At lead you have, in
this one fection of the Sepulchretum («), nine inftances thereof. To which
there are many that might have been and may be added.
For I have now, in my hands, four or five difiertations, in which " the
" uterus ruptur'd in child-birth," is treated of. Each of thefe advances new
examples •, and not only that, but one of them, as for inftance that which is
publifh'd by the celebrated Behlingius (<?), points out other not very recent
examples at the fame time.
The frequency of thefe cafes may be conceiv'd of, even from the writings
of our Veflingius (p) ; and it is furprizing to me, that, as many learned men,
certainly, have collected examples of the uterus being ruptur'd by the foetus,
none of them fhould have mention'd him.
For Veflingius having written of one of thefe cafes, which had occur'd to
him in the year 1640, laid afterwards, in the year 1647, the following words :
u the uterus itfelf is ruptur'd, which happens more frequently than is com-
" monly fuppos'd •, and has been found by me four times already, in the dif-
" fe<5tions of gravid women."
And the afiertion of Veflingius, befides thofe three inftances that were met
with by Santorini (q), is not only fufficiently confirm'd by the teftimony of
one furgeon, who affirm'd to the Royal Academy of Sciences at Paris (r),
that he had feen fixteen inftances within thirty years ; but is alfo ftill more
confirm'd by that of the celebrated Haller (*)., who faw the fame cafe *' three
" times, within fifteen months."
It is true that thefe are not all of them inftances of the uterus being rup-
(n) Obf 2. §. 4. & obf. 3. §. I. 2. 3. 4. 9. (p) Epifl. Med. 25. &4J.
10. 11. & obf. 7. §. 3. & obf 12. §. 2. (q) Ill-oria d'un Feto & est. n. I J.
{0) Med. fuper cafu rupt. in partu uteri, §. (r) Hill. a. 1724. obf. anat. 4.
5. & 11. (s) De Rupt. in part. Utero obf. n. 1.
3 tur'd*
Letter XLVIN. Article 31. 729
tur'd, Co that the foetus burft forth into the cavity of the belly ; and could
not be difcharg'd by the mother, or extracted by the furgeon. Yet molt of
them are : and the others fufficiently mow, how fatal either an incipient, or
a perfect, rupture of the uterus mult be.
As thele misfortunes then are fo frequent, it is not without reafon, that
fome fufpect this ought to be plac'd among the other caufes of the unex-
pected death of a woman, when coming on foon after delivery ; efpecially
if death itfelf come on with thole fymptoms, which Celfus (t) has given as
the figns of the heart being wounded : for thole who die of a wound in the
uterus, fays he, " have the fame fymptoms as thofe who die of a wound in
" the heart («)."
And if they die without bringing forth the foetus, and confiderable and
ftrong motions thereof have been previoufly perceiv'd, but upon thole errors I
have mentioned being committed by the midwife, both the efforts of the foe-
tus, and of the uterus, have been fupprefs'd ; and foon after the fymptoms, I
have referr'd to, mow themfelves in the woman •, there is much more room
for the fufpicion : although we are feldom at liberty to confirm it by diffec-
tion, where even the molt certain marks of the infant being dead with the
mother, do not offer themfelves; as, for inftance, the coldnefs of the arm,
which moil of them, who do not burft forth, with their whole body, into
the cavity of the belly, after the rupture of the uterus, are wont to thrull
out by the vagina ; the coldnefs, I fay, of the arm, an incipient kind of
putrefaction, and other appearances of this kind ; for the relations and
friends, and particularly the hulbands, being averfe to the diffections of their
wives, do not fend for the diffecters, but undertakers-, and deliver both
mother and infant up to them •, fuppofing them both to be dead already.
31. But as the caufe of the uterus being ruptur'd, is frequently the ob-
lique polture of the infant, when he endeavours to extricate himfelf from his
confinement ; and as this obliquity generally happens from the obliquity of
the uterus itfelf; I cannot help wondering, with Reimannus (x), how it hap-
pen'd, that, as the ancient phyficians were folicitous about diftinguifhing,
and curing, this diforder of the uterus, it mould have been neglected in the
latter times by molt phyficians.
He mult have been very little converfant with Hippocrates, who is igno-
rant that he has fpoken of " uteri being turn'd towards the groins, or the
*' pubes," or, on the other hand, backwards " towards the facrum (y)" or,
" to the right, or left fide," or " inclin'd to the hip (2)," or " having a
" tranfverle and oblique fituation (a) f and, in like manner, that " the ori-
" (ices of thefe uteri" are made oblique at the fame time (b) ; and, as we
have hinted already on a former occafion, that it is exprefsly faid, " if the
** uteri become oblique, their orifices become oblique alfo (c) ;" to omit many
other paffages of the fame author.
And not only in the age of Galen (d) ; but purpofely to pafs over many
ages, and many phyficians, who follow'd him ; when Joannes Mathseus de
(/) De Medic. 1. 5. c. 26. n. 8. (a) N. 36.
(«) Ibid. n. 13. {b) Ibid.
(x) Eph. n. c. cent. 9. cbf. 79 in Schol. (c) De Nat. Muliebr. n. 34.
(_>•) De Morb. Mulier. 1. 2. n. 33. (d) De Loc. Aff. I. 6. c. 5.
V'ol. II. 5 A Gradi
730 Book III. Of Difeafes of the Belly.
Gradi (c), our Hercules Saxonia (f)> Rodericus a Caftro (g\ and many others
after them, flourifli'd, midwives, and medical women, were order'd to in-
quire into the pofition of the os uteri, by the infertion of the finger ; that
from thence they might diflinguifh to which fide the uterus was inclin'd.
But if you compare Sennertus (h) with thefe authors, you will readily un-
derlland to how little the whole affair was already redue'd ; and how (lightly
it began to be touch'd upon. And if you look into Riverius, you will find
that the treating of tins diforder was wholly omitted.
In our memory, this almoft obfolete opinion was reviv'd by Deventer (i)
in particular •, and in fuch a manner as to mow (which I do not remember to
have been done by the ancients) of how much importance it is to diftinauifh
the fituation of the uterus in women in labour, from the fituation of the os
uteri •, for that difficult births often happen from the obliquity of the
uterus.
To this opinion I fee that many eminent men have aflented, and do aflent.:
although fome difagree as to the caufe of that obliquity. Thus in two dif-
fertations publifh'd by two difciples of the celebrated Friedius ; one in the
year 1736, the other eight or nine years after-, I remember that this caufe
is plac'd in one fide of the matrix being made heavier, on account of the
placenta being fix'd to it ; which does not happen frequently ; and the foetus
being annex'd to that ; juft as Gradius (k) formerly, among the caufes pro-
ductive of obliquity in the uterus, plac'd this, if " by reafon of the quantity
of matter" in one part of it, " or by reafon of an acquir'd gravity, a drag-
" ging of the other parr, towards this, was brought on."
And even the obfervation which is the laft of all added to this feclion of
the Sepulchretum, feems to be confonant to their opinion.
Yet the ancients fuppos'd the chief caufe to confift in the contraction of
the ligaments of one fide •, or even in the relaxation thereof: fo that the
found part was drawn to the contracted, or the relax'd part to the found.
And this opinion I am at liberty to transfer, from the adventitious difor-
ders of thefe ligaments, to thofe which may alfo exift from the original for-
mation •, and this in confequence of what I have feen in diflections. For, in
the autumn of the year 1706, I found the ligaments of the left fide fhorter
than thofe on the right, in a young virgin of Bologna ; from whence the
uterus inclin'd to the left fide.
And nothing forbids us to fuppofe, that, if the uterus, from an original, or
adventitious caufe, be inclin'd to one fide, in unimpregnated women, when
they become pregnant it mult hang to the fame fide ; if nothing happens to
prevent it. At lead it muft, of courfe, hang to the fame fide for the firfi
months of pregnancy.
And as it has increas'd with that inclination •, although afterwards it raifes
itfelf up above the ligaments ; it is mod probable it will continue to be in-
clin'd to the fame fide, whereto it was before inclin'd. You therefore have
((•) Pratt, tr. 4. c. 22. (/') Obf. Chir. novum lumen Exhib. Ob-
(f) Praleft. Pratf. p. 3. c. 11. ftetric.
(g) De Morb. Mulier. 1. 2. c. 17. {k) C. 22. cit.
(/j) Med. Pratt. 1. 4. p. 1. f. 2. c. 15. in
pcinc'p. & c. 16. in fine.
many
Letter XLVIIL Article 32, 33. 731
many caufes to which you may afcribe the obliquity of the uterus, and
foetus.
Nor would I have you fuppofe that to be very rare, which I laid down
iii the laft place; although you fee that, as yet, there are not wanting thole
who agree with de Graaf (/), when he aflerts that the oblique uterus had been
met with by him " fometimes, though but rarely."
That this appearance has, at lealt, not happen'd rarely to me, you will
underltand from my oblervations ; eight of which I have already written to
you («;), befides that whereof I fpoke jull now, as taken from the young
virgin : two or three I will give you at another time, as relating more to
another lubjecl: : but I will here moreover add five ; which I (hall not readily
find opportunity to introduce elfewhcre.
52. A (trumpet, who was lame, of a fmall ftature, and aged forty years,
was taken off within a few days, in this hofpital, and in the beginning of
March 171 7, by an inflammation of the thorax. At this time I was wholly
taken up in the anatomical examination of the parts of the belly ; for which
reafon I inipected only this cavity.
The abdomen, before I began the difiection, fhow'd many cicatrices from
buboes. And when the cavity was open'd, the inteftines were turgid with
flatus; and, for that reafon, appear'd remov'd from their more frequenc
fituation.
That part of the fmall inteftines which lay neareft to the thorax, had be-
gun to be a partaker of this inflammation, as frequently happens : nor was
the liver quite free from the fame diforder. The kidnies were enlarg'd, and
in the pelvis of them was a kind of purulent urine. But the coats of the
bladder were thick ; and their internal furface unequal •, perhaps from the
lues venerea having infefted the urinary organs, as is often the cafe.
One of the tubes of the uterus was agglutinated to the neighbouring tefticle ;
yet in fuch a manner, as to correfpond with its free and unconnected orifice,,
to the part of that teftis in which a large veficle was included. The other
part was not very found ; fo that for this reafon, perhaps, that, othervvife
very (lender, ligament, by which it was connected to the uterus, had ber
come thick.
The uterus, which was in other refpects in a natural date, inclin'd to one
fide-, but whether to the left, or to the right, 1 have not committed to
paper.
33. Notwithftanding I have faid that this woman was lame, and one of
them was lame in whom I (hall hereafter defcribe (n) an inclination of the
uterus : although Galen (0) feems to hint that thofe women, in whom is this
inclination, have fometimes " a pain that goes into the hip : and that the op-
" pofite leg is fometimes lame in walking :" and Sennertus (p) tells us of a
certain woman from Philaltasus, who was fuppos'd " to labour under a fcia-
" tica" for that reafon; and Saxonia (q) confider'd limping as a mark to
which fide the uterus inclines ; and adds, that not only the lame limb, but
(/) De Mulier. Organ, c. 8. («) Ep. 56. n. 26.
(«) Epift. 29. n. 12&23; Ep. 35. n. 12 [e) C 5. fupra ad n. 31. cit.
& j6; Ep. 40. n. 24 ; Ep. 45. n. 16 ; Ep. 47. (/) C. 16. ibid. cit.
n. 18 & 36. (?) C. 11. ibid. cit.
5 A 2 the
732 Book III. Of Difeafes of the Belly.
the upper limb alfo, on the fame fide, is, from his own obfervation, affected
with a tremor and ftupor ; yet they either mean a much greater inclination
than I found •, or a tumour and pain of the uterus, which Galen (r) probably
refer'd to, is join'd to the inclination •, ib that by thefe means there might be
a prefiure and tenfion of the nerves which go to the leg, through the fame
fide of the pelvis, and are connected with the nerves of the upper limb, by
the intercoftal. I at leaft, in the greateft part of thofe women in whom I
have feen the uterus inclin'd to one fide, have not even obferv'd a lamenefs
in any, and ftill lefs have obferv'd the other fymptoms that are mention'd.
And as to Hippocrates (s) having faid, " if the leg be made lame from
" the uterus after delivery," that is, as he explains it himfelf, in another
place (t)t " from the uterus being inclin'd towards the hip j" Reimannus(«)
will mow you how you may underftand this, where he produces two instances
of lamenefs feen by him after delivery.
I would alfo have you read the conjecture of Schoenmezlerus (x) ; who,
having frequently heard lying-in women " complain of a violent pain in the
" region of the larger trochanter, and in like manner a fenfible drawing of
M the fame, towards the exterior, or pofterior parts •," and having obferv'd
that a virgin, who labour'd under a cancerous excrefcence of the vagina
uteri, was troubled " with fimilar, and even greater, inconveniences •" con-
jectur'd that the mufcle, which lies next to the uterus, on the internal furface
of the pelvis ; I mean the obturator internus ; may in violent pains, and
throes, of child-bearing, " be bruis'd, inflam'd, ulcerated, or in any other
" way injur'd ;" and by this means occafion that pain, and drawing, in con-
fequence of its being terminated " in the notch of the great trochanter."
And, as you confider thefe things in your mind, you will naturally con-
ceive, that in the throes of a difficult birth, other mufcles, alfo, that lie near
to the diftended uterus in the pelvis, and particularly the iliacus internus,
and that which is call'd the pfoas, may receive fome injury; and that, as
thefe mufcles go to the other trochanter, and raife the thigh, they may caufe
not only a pain, like that obturator in lying-in women, but alfo a difficulty
of raifing the thigh •, which according to the different degree of injury is
greater or lefs, or fhorter, or of longer, continuance : for fometimes it is
even perpetual-, as I have feen in a noble matron, who was my wife's mo-
ther; which lamenefs fhe faid had been left after a difficult birth of that
kind.
But whether this had taken its origin from the fame caufe, in any of thofe
we diffected, I cannot now certainly remember. However •, to return to
the fubject •, I have alfo found the uterus inclin'd in fome gibbous women :
yet not fo that the gibbofity was brought on by the inclination of the ute-
rus, but on the contrary the inclination of the uterus by the diftortion of
the fpine ; as certainly happen'd in thofe two of whom I fhall immediately
fpeak.
34. A gibbous old woman was brought into the hofpital, when her dif-
eafe was fo far advane'd in its progrefs, that it was not in my power to learn
(r) C. cit.
(s) De Morb. Mulier. 1. 1. n. 16.
(0 L. 2. n. 35.
(«) Schol. fupra ad n. 31. cit.
(x) Commerc. Liuer. a. 1736. hebd. 43.
11. 2.
who
Letter XLVIII. Article 35, 36. 733
who fhe was-, for no fooner was flic brought in but flic died. Wherefore I
demonftrated but very few things, from her body, to the pupils; and in-
deed lb much the fewer, as I was furnifh'd with a very good male body at
that time •, from which I was teaching, in the theatre, about the latter end
of January in the year 174S.
In the thorax I inlpected nothing elfe but the heart, which was in a na-
tural ftate-, although it was furnifh'd with four coronary arteries, as I Hull
defcribe on a future occafion.
And in the belly, the kidnies had not a very found furface •, fo that I
was lefs furpriz'd to find the bladder, in which there was a great quantity of
urine, having its cervix well diilinguifh'd with fanguif'erous veflels.
The right teftis was fomewhat turgid, juft as if it had been the teflis of a
young woman •, but it was diftended by an hydatid of a confiderable fize,
that was included in its body. And finally, the fpine was diftorted to fucli
a degree, that the uterus inclin'd to the right fide ; and the left iliac vein
was twice as long as the right.
35. The kidnies, and genital parts, of another gibbous old woman, who
had died in the hofpital of a long-continued and very violent ulcer of the
leg, were brought to me into the college •, almoft at the fame time of year,
but two years before.
The right kidney was of a natural form and magnitude. But the left,
although it equall'd that in length, was fo much lefs in width, that the ap-
pearance naturally occur'd to the eyes of every one immediately.
Whether this was owing to the fpine being diftorted towards the left fide,
at the upper vertebras of the loins, I cannot determine, as I did not fee the
body myfelf. Below, however, it was certainly fo inflected to the right
fide, that the uterus hung towards the fame fide : and this appear d from
the round ligament of the uterus on the right fide, being much fhorter than
the left : for that I might be convine'd of this fhortnefs, thofe who had .
taken the parts out of the body, had left the fmall part of the abdomen,
through which it came out from the belly, connected thereto.
36. Yet I have feen the uterus drawn to that fide •, by reafon of one of
the round ligaments being very fhort-, in three other women, whofe hifto-
ries you have formerly receiv'd (y). And that I take notice of for this rea-
fon ; becaufe, after Riolanus (2) ; who mentions only the broad ligament,
which alone was probably fhorter than ufual, in his obfervation of this kind ;
I fee that others are not wanting, and among thofe Weitbrecht (a), who fup-
pofe it to happen always from one of the ligamenta lata.
However, as I think that it fometimes happens from the fhortnefs of both
ligaments, in one and the fame fide, or from the laxity of them in the other
fide •, fo I imagine that the fame circumflance may, at other times, be owing
to the ligamentum latum only being fhorter, if its fellow round ligament
be very lax ; or to the round ligament only, if the broad ligament be
very lax.
But to the laxity of both the broad ligaments I attribute the falling back-
(y) Epift. 29. n. 12 & 20; Epift. 35. n. (%) Anthropogr. 1. 2. c. 35.
16. (a) Syndefmolog. fed. 6. § . 41.
wards
734 Cook III. Of Difeafes of the Belly.
wards, or forwards, of the uterus •, as in the woman of whom I wrote to
you in the forty-fourth letter (Jb) ; although in her the left muft have been
lbmewhat lefs lax, or lefs fhort, as the uterus was fomewhat nearer to the left
fide than to the right. Now take the remaining obfervations.
3j. A woman, of about five and thirty years of age, had, not long be-
fore, had a vomica ruptur'd in the lungs, when (lie gave fuck. As long as
me could expectorate fhe liv'd. But at length ; her expectoration havino-
Itop'd for the fpace of two days ; fhe died in the hofpital, in the beginning
of December in the year 1740.
As the body was not emaciated, and very proper for anatomical inquiries,
molt of the parts were differed and examin'd •, except the thorax, which I
purpofely omitted opening ; but none with fo much care as the belly.
In this cavity then, fome appearances were obferv'd, that do not relate to
the prefent fubjeft ; but among others were the following. The Itomach,
which was very long, before it reach'd to the antrum pylori, contracted it-
felf to the extent of fome inches; and foon after expanded itfelf into that
antrum.
The inteftinum colon was alfo contracted, in its beginning, to fuch a de-
gree as fcarcely to exceed the thicknefs of a man's thumb. The fmall in-
teftines feem'd to be inflam'd as it were, in fome places, on the left fide ;
nnlefs this might happen to be fo from round worms, one of which was in
the ftomach.
The fpleen was of a flefhy colour internally ; not black ; and almoft of its
natural magnitude.
But the liver was large-, extending itfelf into the left hypochondrium ; and
had its right lobe divided almoft into two lefTer lobes, on its concave fur-
face, by a deep and not fhort fiflure. I found the roots of the hepatic duct
within the liver, which was, in other refpedts, found, much thicker than the
thicknefs of thofe that lay on the outfide of the liver, feem'd to require in
proportion.
The furface of the kidnies was unequal in fome places ; yet they were found
in their internal fubftance. In the cavity of the pelvis of the abdomen was
a fmall quantity of water.
The uterus was very much inclin'd to the right fide ; fo that the tube, and
the teftis, being fore'd into a narrow compafs in that part, had a much more
extenfive fituation in the other. Finally, the trunk of the vena cava be-
ing cut acrofs at the diaphragm, fome black and coagulated blood flow'd
down.
38. An old woman had her right leg bitten by a dog •, after which an in-
tefcinal Mux had come on, and a llight fever.
After many days the former ceas'd ; but the latter continued. She was
then feiz'd with a vomiting, by which fhe threw up fome worms. And at
length her vomiting ceafing, fhe fank by degrees, and died, in the hofpital,
about the beginning of March 1741.
This patient never had her pulfe ftrong -, yet fhe had intermiffions now and
then : there was fometimes a cough alfo, but this was flight. And why I
(h) No. 16.
added
Letter XLVIII. Article 38. 735
added theft two remarks, you will conceive naturally of yourfclf, when I tell
you prefently what I obferv'd in the heart, and about the lungs. For I not
only cxamin'd the internal parts of the belly, but of the thorax and head
like. wile •, and other parts beiides, of this very lean body, within a few
days : and that very accurately.
When we were about to diifccl: the brain, we obferv'd air-bubbles in the
veffels of the pia mater : and under this membrane was water ; as there was
alio in the ventricles,' but not in great quantity, nor fo as to make the cho-
roid plexufies pale.
On opening the thorax, we found the lungs to be turgid with air-, and
about them were many bronchial glands, fome of which were much enlarg'd,
and contain'd a tartareous matter within them.
Both the ventricles of the heart were ftuff'd up with polypous concreti-
ons, among which was a black blood •, being themfelves of a white colour
inclining to yellow ; and fome of them thick, and not eafily to be pull'd
afunder.
The valvula? mitrales were made up, at their lower part, of a compact
and white Jubilance internally •, and particularly in that part which is neareft
to the great artery.
None of the valves of this artery were quite free from beginning oflifica-
tions : and one of them, on the furface that wasturn'd to the paries of the ar-
tery, was almoft univerfally bony ; and for that reafon rough, and unequal, with
particles which you would have faid were real bones •, being here and there
protuberant like grains of fand, and fome of them lying upon each other.
On the other furface, the corpufcle which was reftor'd by me, being pull'd
away at the upper part, had degenerated into a flefhy excrefcence, fome what
larger than itfelf.
In the belly, which we open'd firfl of all, the ftomach appear'd to be
fomewhat tumid with air ; being large of itfelf, and coming down fo low,
that the inteftine colon, which lies beneath it, was below the navel. And
the whole of this inteftine •, as in the woman laft fpoken of (c) ; except at its
beginning, which together with the caecum was turgid with air, had fo con-
tracted itfelf, that it feem'd to be one of the fmall inteftines. On the other
hand, the duodenum was much larger than it generally is ; and moreover
pafs'd downwards, over a very long tract of vertebras, on the right fide. The
other fmall inteftines were of a pale and livid colour.
The glands of the mefentery were not very fmall, but of a middle fize -,
being fenfible both to the fight, and touch, under a fmall quantity of fat.
The liver was large : and in it two furrows, as if made by a ftrong impref-
fion of the fingers, defcended in a fituation almoft parallel to each other-:
and that from the upper part of the convex furface, to a considerable tract in
the anterior direction.
The fpleen was thicker than is natural; and on its gibbous furface fome-
what rough, with a kind of whitifh granules, and of a pallid colour in-
ternally.
(0 N. 37.
finally.,
736 Book HI. Of Difeafes of the Belly.
Finally, the uterus was inclin'd to the left fide, and had its whole internal
furface rough ; but not ulcerated, although cover'd over with black blood •,
the whole internal furface, I fay, of the fundus, but not of the cervix-,
although the corona of the ofculum uteri was fomewhat thicken'd.
39. Nor am I wanting in other obfervations, befides thofe that I have
promis'd, of the the uterus being inclin'd to one fide -, but from a tumour
in the oppofite fide.
Thefe, however, are fufrkient, at prefent, which I have added to the
eight already given you in former letters; firft to Ihow you that the obli-
quity of the uterus is not very rare •, and in the fecond place, that by com-
paring them all, one with another, you may know whether this, as fome
feem to believe, happens more frequently on the right fide, or not lefs fre-
quently on the left.
I have not leifure here to examine the obfervations of others. But out
of the two, however, which I remember to have read in the Sepulchretum ;
the one of Joannes Riolanus (i), the other of Francifcus Sylvius (?) ; the
former defcribes it as being towards the right fide, and the latter towards
the left.
And finally, by comparing all our obfervations together, you will natu-
rally collect this remark: that the women, in whom this diforder of the ute-
rus was found by me, had not complain'd of thofe violent fymptoms, which
Ruyfch (f) fuppos'd to be the effect of a lateral inclination of the uterus ; I
mean a pain of the hypogaftrium, a very frequent effort of expulfion, a conti-
nual defire of making water, or at leafl not a very quick and eafy difcharge of
the urine •, notwithstanding in fome of them this inclination was far from
being inconfiderable, and the frequent interrogation of phyficians was not
wanting, in order to difcover every complaint wherewith they were troubled.
And indeed the figure of Ruyfch's (g) ; in which the inclin'd uterus is
reprefented ; does not ihow that part of the vagina which is annex'd to it ;
and to which we know that the beginning of the urethra clofely coheres ; to
be fo inclin'd, as would be neceflfary in order to account for thofe difagree-
ble fymptoms in difcharging the urine, that Ruyfch has attributed thereto.
But of the obliquity of the uterus enough.
There is a rare obfervation of contorfion being added to obliquity, which
may be read among the hiftories that are in the latter part of the excellent
differtation of Rudolphus Jacobus Camerarius {h). For the uterus was
found u fo inclin'd to the left fide, that the anterior part of the fundus
" feem'd to be diftorted, towards that fide, at the fame time."
And this contorfion was, as is faid foon after (i), " confpicuous •, and by
" contra&ing the orifice of the uterus, perhaps impeded the birth at the fame
-" time •," particularly of the foetus, which was not properly plac'd, was
larger than the ufual fize, and in a mother who was fmall, and in like man-
ner fat.
(;/) Seft. hac 38. obf. 9. §. S.
,(vj) Seft. 10. libri hujus 3. obf. 28.
(f) Cent. obf. Anat. Chir. 88.
(g) Ibid. fig. 69. *
(Z>) Specimen. Experimcn. circa Generat.
Hift. 1.
(/') In Schel.
4
You
Letter XLVIII. Article 40. 737
You fee how many caufes of unfuccefsful birth, may fometimes come to-
gether, at one time. But there are ftill others; as when the cervix uteri is
flwt up by fomc excrefcence : which was the cafe in the woman whofe dif-
fe&ion we have in the hiftory of the Royal Academy of Sciences at Paris (jfc):
or when the os uteri is almoft of a cartilaginous hardnefs, fuch as it was found
to be in a woman not yet forty years of age, by the celebrated Helmftad
profcflbr, Fabricius (/) ; nor did he think it was without reafon that he rec-
kon'd it among the other caufes of a difficult and preternatural birth, as giv-
ing very great refirtance to the dilatation neceflary for delivery : or when the
funiculus umbilicalis is much fliorter than it generally is, and is an obftacle
to the efforts of the foetus, in endeavouring to extricate itfelf •, or if thefe
efforts are very ftrong, is apt to produce an untimely feparation of the pla-
centa ; and even is apt itfelf to be broken alunder.
Thus you will lee, in how much danger both mother and foetus were,
when a funiculus " fcarcely fix inches long," was. feen by the celebrated
Stegmannus (m).
But out of the other caufes of difficult birth ; fince they are almoft innu-
merable, and we have a great number of different caufes ftill remaining ; it
will be proper to fpeak of one, which is a very common one among the prin-
cipal of thefe caufes.
40. This is the foetus when dead in the uterus : which firft creates this
difficulty •, to make it very doubtful, whether it be really dead.
There were, formerly, fome who acquiefe'd too eafily, as melancholy ex-
amples have taught us, in certain figns of the death of the foetus ; and if the
meconium, for inftance, flow'd down through the pudenda of the woman in
labour, they did not hefitate to pronounce that the foetus was already dead.
The fallacy of which fign, not only others, in other places, but I myfelf have
very evidently found here, in the year 1730.
The wife of a tradefman, who was about nine and twenty years of age, .
having drunk water inftead of wine, almoft in general for the fpace of three
years ; and having come to the regular period of her fifth or fixth pregnancy
with good omens-, difcharg'd fo great a quantity of waters, at one and the
lame time, from her genitals, that every one was furpriz'd at it ; but not fhe
herfelf.
For fhe knew that fhe had drunk much more water in this pregnancy than
ufual •, and that lefs had been difcharg'd by the urinary paffages for the laft
month than ufual.
She was furpriz'd however, as the infants had always hitherto immediately
rcllow'd the effufion of the waters, together with their fecundines, and the
births had been very happy -, notwithftanding the children had all ceas'd to
live within fifteen day •, fhe was furpriz'd, I fay, that her waters having been
diicharg'd on the preceding day in the morning, which was the eighteenth
of February, another day had now come on, and nothing had been difcharg'd
befides a watery humour, which ftill continu'd to flow ; when behold ! on the
fame morning, the meconium began to flow together with that fluid.
{k) A. 1705. obf. anat. 7. (»<) Eph. n. c. dec. 3. a. 4. obf. 113.
■) Progr: Acad. edit. a. 1750. m. Januar..
Vol. II. c B Where-
73 8 Book III. Of Difcafcs of the Belly.
Wherefore, in the afternoon I was fent to, and defired to go and fee her,
and confult with her phyfician upon the cafe.
Upon hearing that this gentleman intended to do, and to give, fuch things,
as he hop'd would bring back the pains, and efforts, of the uterus, that were
gone off; I told him, that I thought the firft inquiry to be made, was, whe-
ther the foetus was difpos'd in fuch a figure, as is requir'd in a natural ftate ;
from which, I fear'd, if it were living, it was far diftant : and what made me
fear this was the difcharge of the meconium.
I inquir'd what was the report of the midwife. And was anfwer'd that
fhe, as far as could be judg'd from the examination of the abdomen of the
mother, fuppos'd the foetus to be plac'd tranfverfly. But that it was alive
the mother did not doubt, as fhe thought fhe had heard it cry. But let us,
faid I, pafs by this notion of the child's crying, which is an uncertain fign.
Yet why was not the former which confirm'd my opinion (for the anus of
the infant being turn'd towards the vagina, and the parts adjacent to the anus
being probably comprefs'd, the inteftinal excrements might be fore'd out,
even before the infant breath'd) afcertain'd to the midwife by the introduc-
tion of her fingers ? The mother, fay they, refufes to fubmit to it.
But what, faid I, if it fliould be neceflary to introduce the hand into the
uterus, and extract the foetus ; after having firft turn'd it to a more proper
pofition, if that fliould be neceffary. And if her mind cannot be now in-
iluenc'd ; you may take it for granted, that unlefs the midwife is deceiv'd,
or the figure, which fhe has fpoken of, is chang'd to a better, the infant will
not be born, at laft, without the afiiftance of a furgeon, which may perhaps
be too late.
One or other of thefe fuppofitions muft have taken place. But whichfo-
ever was the cafe ; they faid that the pofition was afterwards chang'd, and
that the pains of labour coming on, the infant was, at length, born in its na-
tural figure; though not without great difficulty on account of its mag-
nitude.
This however is certain, and what relates chiefly to the point in queftion ;
that the child was not born before the eighth hour of the following day, and
was ftill alive: that is at lead fifteen hours from the time in which, being in
the uterus, it had begun to difcharge its feces : and it even liv'd a little while
after the birth ; fo as to make it very evidently appear, that this difcharge is
a deceitful mark of the foetus being dead.
And I have given you this relation, becaufe it is only by inculcating ftill
other and other obiervations, from time to time, that thefe errors, and pre-
judices, can be rooted out from the minds of weak women and common
people.
For it does not efcape me, as I faid above, how often the fame thing has
been before: and indeed •, to omit other examples; one of the hiftories juft
now mention'd (n), when I took notice of the distortion of the uterus, will
plainly (how you, that a girl was born living, healthy, and brifk on the fifth
day after the meconium was difcharg'd.
Nor is it only that fome compreffion ; efpecially of the belly, which eafily
(») N. 39.
happens
Letter XLVIII. Article 41. jfjg
happens when the body of the foetus is not folded into the mod fuitablc pol-
tore*, but that either the greater quantity of feces, which are then almolt
fluid, or the acrimony of them, by irritating the inteftines ; may overcoiv
power and refiltance of the circumjacent fphincter, which at that time are but
lmall.
And mud it not happen, that this power of the fphincter is fometimes al-
moft nothing at all •, and not only by reafon of the great infirmity and weak-
nefs of the foetus, but by reafon of a paralyfis ? And it concerns phyficians ;
who are not willing to be deceiv'd, even by many other figns that are gene-
rally fuppofed to argue the death of the foetus •, to remember with careful-
nefs, that the ftrength, and retention, of the foetus, may be foon after re-
ftored ; as after a fyncope, by cheering and comforting the foetus together
with the mother •, or if not wholly reftor'd, at lead in great meafure.
Suppole, by way of another example, that there is no pulfation in the um-
bilical rope, and even none in the arteries of the foetus. It is, without doubt,
certain that the foetus is alive, if a pulfe is really perceiv'd. I faid really -, for
what Lancifi (o) relates to have happen'd in refpect to a man of the firft rank •>
that, in his wrift after death, I know not who contended there was a pulfe,
which in fact, was no where except in his own fingers ; I fear may much more
eafily happen to a furgeon, who, in order to inquire into this circumftance,
has introdue'd his fingers, after being heated within the warm parts of the
woman, and by the operation itfelf.
And I commend thofe, who, in order to avoid this fallacy, have ad-
monifh'd the furgeon, that he, at the fame time, compare the number of
pulfes perceiv'd by him, with thofe of his own at the wrift ; which ftie muft
take care to have obferv'd by fome other perfon •, fo that if the numbers
exactly coincide, he may be fure he is deceiv'd : but if on the contrary, that
he is not deceiv'd.
Yet although that which we have faid is certain •, it does not immediately
follow, that the foetus is dead, if there is no pulfe : for the ftrength of the
foetus may then be very languid, but foon after return.
And neither the fatal deficiency of pulfe, nor the coldnefs, nor lividnefs,
of the funiculus, nor of a limb of the foetus hanging out of the uterus, give
a fufneient proof of the child's being extinct : for they may be fo conftricfted
within the narrow paffage of the contracted os uteri, that if a gangrene even
begins to affedt the limb, and the cuticle begins to be feparated from it;
though it is very evident that the life of the infant is in very great danger,
yet that life is entirely extinguifh'd, is by no means certain and evident.
And indeed at Breflau, although the arm of the infant was hanging out
" in a livid and cold ftate," fo that it was judg'd proper to amputate it, as
if the foetus were without doubt dead ; yet this foe:us was born (p) " on
" the third day and living."
41. However, where either the very feries of evident caufes, and circum-
ftances, or the greater part of the figns, and thofe fuch as are to be depended
upon, or at leaft of the molt importance ; of which kind are the very eafy fe-
paration of the cuticle from the head, a humour of a cadaverous fmell dif*
(0) De Cubit, mart I. I.e. 16.1l. $. 57. in fin.
5 B 2 tilling
74° Book III. Of Difeafes of the Belly.
tilling from the uterus, and other figns of the like kind •, where thefe fymp-
toms, I fay, have induc'd the more fkilful phyficians, and furgeons, to fup-
pofe, with unanimous confent, that the infant is dead within the uterus •, an-
other difficulty naturally arifes : that is, whether it is better immediately to
extract it with the hands, or to make ufe of other remedies previoufly
thereto.
I remember, that, when I applied to the ftudy of phyfic at Bologna, it hap-
pened to two illuftrious matrons, in one and the fame year, that they could
not bring forth their children; and as the foetus of each of them was fup-
pos'd to be dead, that in one it was taken away by the hands of the furgeon ;
but in the other, that, by patience, and waiting, and particularly by the ufe
of a clyfter, that was emollient and ftimulant at the fame time, the fcetus
was difcharg'd ; the former mother dying foon after, but the latter being
fav'd.
Although the gentleman who had been phyfician to both of them, a very
learned man, gave his reafons, why, in the former cafe, he thought it ne-
ceffary to haften the event, and why in the latter there was room to wait ;
yet he did not get praife, from the recovery of the one, equal to the re-
proach he got by the lofs of the other : reproach that was in my opinion
unjuft, but prevail'd even among phyficians and furgeons of eminence.
And although it is not at all to be doubted, but it becomes phyficians to
aft differently according to different circumftances •, yet it is fcarcely pofllble
to avoid cenfure, unlefs you act in confequence of the unanimous opinion of
the moft celebrated phyficians, in the ufe of every doubtful remedy : and
efpecially if it happen, as in this cafe, that the afliftance of a fkilful and ex-
perienc'd furgeon is wanting.
Nor is it fufficient to fave the patient, we muft alfo fee that no injury is
done to the uterus.
I was confulted fome years ago, for a gentlewoman, who, after four very
iuccefsful births, had had occafion, in the fifth, for the afliftance of a fur-
geon ; who having it in his power to extract the infant eafily by the feet,
(which he ought to have done) as it prefented with them, pufli'd them back
neverthelefs ; and while he was endeavouring to turn the head to the orifice
of the uterus, and extract the fcetus by laying hold of it, he teaz'd the wo-
man, who was, in other refpects, of a delicate habit, fo long and fo violently,
that not only an inflammatory fever, which brought her almoft to death's
door, was excited ; but alfo, in the three following times of child-birth, the
infants never prefented themfelves with the head, but always thruft out the
hand : and it is very fuppofable that this was owing to an injury being done
to a certain part of the uterus, which prevented it from fuftaining, or ex-
pelling, them equally, on all parts ; and was thereby the caufe of a preter-
natural pofition.
For which reafon, if there is nothing that requires hafte, and the pofition
of the dead foetus is not bad, the greater time is, in my opinion, to be given
to the woman, and to nature ; that the latter may excite the efforts, and pains,
of child-bearing, and the former, by collecting her ftrength together, may
contend, with all her might, to deliver herfelf of her burden : and it is fome-
2. times
Letter XLVIII. Article 41. 741
times of ufe, to a (lift the endeavours of the mother a little, by applying cau-
tious and fkilful hands to the belly.
But becaufe nature is fometimes very flow in promoting thole pains, or
does not excite fuch as we would wifh ; but rather convullive pains, which
are diametrically oppofite to our purpofe ; it will be our bufinels to appeafc
the latter in time, and to promote the former, if that is really in our power.
I remember I was call'd to a woman in labour, who; having been now
troubled with this bad kind of pains, that I have fpoken of, for the fpace
of two days ; could neither get any deep, nor retain any aliment •, but was
oblig'd to throw every thing up by vomiting.
Having, therefore, given this woman half a grain of opium, before her
ftrength was quite exhaufted •, fhe began at once to retain her aliment, and
thefe convulfive pains were at the fame time appcas'd : fo that the true la-
bour-pains coming on loon after, and the orifice of the uterus, which had
been kept in a conltricted itate by the former, being open'd, the child was
happily brought forth.
And in fo doing, I rejoice not only that I follow'd the method of Deven-
ter (q), which I then knew, but alfo the practife of that excellent phyfician
Richard Mead (r), as I now fee.
But in the other cafe of which I fpoke, wherein nature is very flow in ex-
citing proper pains, fhe is firft to be afllfted by clyfters, contriv'd for that pur-
pofe, and undtions applied to the abdomen ; as far as it is poflible to do it
thereby : then, if thefe are not fufficient to anlwer the purpole, by giving
fomething of the fame kind internally, which may invite rather than ftimulate
nature ; avoiding every thing that can agitate and create danger.
You will perhaps laugh at me, if I tell you what I know, from the moft
authentic informations, to have happen'd in the country about Padua, fome
years ago.
A woman could not bring forth. A furgeon in the village where fhe liv'd,
fent four ounces of the oil of leucoion luteum vulgare, wherewith to anoint
the belly as ulual. The ruftic and ignorant women, who were about her,
fuppos'd it to be fent in order to be taken inwardly ; and immediately gave it
her to drink. And by this means fhe was deliver'd.
The furgeon, taught by this cafe, gave the fame quantity of the fame
oleum cheyrinum ; as they call it in the fhops •, to three or four other women ;
who were in a like difficulty •, and with a ftmilar fuccefs.
After this it was given to a woman at Padua in my knowledge, who couli
not bring forth her dead foetus ; and by this means the head of the infant
defcended fomewhat lower : although, by reafon of the great magnitude
thereof; to which the lower circumference of the pelvis was not equal ; it
could not be deliver'd without the afflftance of a furgeon.
That the flowers of the leucoion are given, by phyficians, to promote the
difcharge of the menfes, the foetus, and the fecundines, is extremely well
known. But that the oil, in which thefe flowers have been macerated, had
been given, I do not remember: nor is it to be wonder'd at; as fo many
things lefs unpleafant are fuppos'd to anfwer the fame purpofe.
(q) I. fupra ad n. 31. cit. c. 17. 26. 50. (r) Monk, medic, c. 19. feft. 5.
However,
742 Book III. Of Difeafes of the Belly.
However, it will not be altogether ufelefs, to have taken notice of this alfo?
if any one mould happen to fuppofe, either that the force of the leucoion,
whatever it may be, is temper'd by the oil ; or rather, that, when this force
is in action, it is properly mitigated at the fame time •, if any thing requires
mitigation, as I juft now mow'd in the convulfive pains.
42. As to what I have faid above (s) ; that we may wait, if no occafion
prefles j I would have you underftand it in fuch a manner, as to fuppofe it
allowable, if no figns of a putrefcent foetus begin to appear •, which figns
come on the fooner, where the waters are difcharg'd : for the air enters, thro*
the ruptur'd membranes, to the dead body, and brings on fuch a corruption •,
which, although it even attacks thofe carcafes of the fcetufies, that are not
expos'd to the contact of the air, yet attacks them, for the moft part, much
later, and without any acute fever of the mother : and this you will under-
Itand, from the hiftories which give you the relation of the bones of fcetufles,
conceiv'd iong before, being difcharg'd, either by abfeefles of the abdomen,
or by the anus ; the mother for the moft part being fav'd.
And thefe hiftories have grown out to fuch a number, from the time in
which Albucafis produe'd his (t), that although they are collected by more
than one author, there are fome which we could wifti had been added •, and
many are wanting which were not extant at that time.
One of thefe, in my opinion, is that which Dominicus de Marinis («) pub-
lifh'd, from his own obfervation, in the year 1667 ; the cranium of whole
foetus, as well as the other bones •, that had been excreted by the anus of
the mother •, were preferv'd by Guilielmus Riva.
And there are not a very few of thefe, which even Italy alons has offer'd
in our memory. For; to omit the foetus, which was extracte d from the
rectum inteftinum of a woman, by that induftrious furgeon, at \ enice, Ni-
colas Paulina, and fent to me by him, in order to be examin'd •, concerning
which both he himfelf (x) and Santorini have written (y) ; the fame Santorini
(2) has made mention of a woman-, in the territories of Padua, and perhaps
living at this time ; who had difcharg'd the bones of a foetus by the fame way :
and that celebrated man Francefco Serao inform'd me, by letters dated at
Naples, about the end of the year 1739, that the bones of an infant had
been difcharg'd by another woman, not long before, from the fame place.
And that at Brefcia, and Vercelli, the bones of other fcetufies have been,
in this our age, taken out from abfeefles of the abdomen, our Vallifneri (a)>
and the celebrated Fantonus (£), have aflerted.
And, without doubt, there are other obfervations of this kind, among
my countrymen in this age •, the knowledge of which has not come to me : or
if it has come, I do not at prefent remember them.
But as there is fcarcely any thing in the medical art, which is not liable to
exceptions ; therefore I have fuppos'd, that what I laid juft now of putre-
faction coming on very late, it the air does not enter •, and very loon if the
air does enter, and in a very dangerous manner ; was for the moft part,
(s) N. 41. (y) Inft. d'un Feto kc.
(t) Chirurg. 1. 2. c. 76. fzj lb. n. 31.
(a) Differ:, de re monitrofa per urinam ex- («) I/roria della generaz p. 2. c. 17. n. 17.
creta. {{>) De obf. med. & anat. epift. 7.
(x) Relaz. int. al cadav. d'un Feto & est.
4 but
Letter XLVIII. Article 43. 743
but not always true •, being indue'd to be of this opinion by many oblerva-
i, but particularly by two that were publifh'd in one and the lame year
(f), by thole celebrated men Reufnerus, and Nebelius.
For one of them fpeaks of a foetus, of live months, being dead in the
uterus ; the lame being dilcharg'd after no more than twenty weeks, " with
" a molt filthy odour;" notwithstanding, by reafon of the fecundines, and
the w ters, being, retained at the fame time, no accefs was given to the air.
And the other gives- the relation of a mature foetus, which was endeavour-
ing to procure its own dilcharge at the proper time ; but, after the efflux of
the waters, gave rhe more certain figns of its death, as, in the following
weeks, " a foetid and bloody ichor, with little pieces of membranes, and
" flefhy fibres, flow'd out from the pudenda:" and finally, this foetus was
redue'd to a fceleton ; fo that the crackling of the bones was heard, as often
as ever the woman Dent her body backwards, or forwards : yet (lie, being
afflicted with no fever that is mention'd, nor any other confiderable inconve-
nience, had even carried thole bones in the uterus, " for three years together,
*' without any lofs of health."
And I could wifh, that, as many dead foetufles, befides thofe I have men-
tion'd, have long made their fepulchres within the belly of the mother ; fo,
many living infants might not be buried together with the dead mother ; but
were taken out in proper time from her carcafe.
For while the furgeon is fought after to open the body, while he is call'd
and coming, the foetufTes that were living, and efpecially the more weakly,
frequently die ; the women, and even many men, equally rude, and full of
ignorance with themfelves, taking care to keep the mouth of the mother
open: whereas, they mould rather take pains, with fome hope of utility, that
the body of the mother, and particularly the belly, may be kept warm ;
which not only reafon itfelf fufficiently argues for, but is likewife confirm'd
by the experiment of Stalpart the fon (d), on the foetufles of dogs.
For having put them into warm water, wrap'd up in their membranes, he
found a pulfe in them even after fome hours.
And indeed, upon opening the belly, and uterus, of an illuftrious matron
of Silefia (e) ; who had been dead four hours before the furgeon came ; a
living child was found : the perfons who were about the deceas'd mother,
not having omitted to foment her abdomen continually, till he came, " with
" fpirituous fomentations, with the balfamum embryonum, with generous
" aromatic wine, with warm flannels, and the like;" without being in the
leaft deter'd therefrom, as I fuppofe, becaufe they perceiv'd no motion in
the uterus.
For otherwife, the writer of the obfervation would fcarcely have fubjoin'd
the following words, which are frequently true : " for the foetus is mod ge-
" nerally alive ; notwithftanding there is no evident motion."
43. But in regard to women in labour, I have fpoken fufficiently. Let us
now add a few things, alfo, in regard to women after delivery. And to this
fubject relates the obfervation which I made, on the twelfth of Auguft, in
(c) Eph. n. c. cent. 5. obf. 11. & cent. 6. (d) Exercit. de nutrit. fetus §. 41. in fine,
cbf. 52. (t) Eph, n. c. cent. 3. obf. 57.
the
744 Book III. Of Difeafes of the Belly.
the year 1707, together with my very learned Venetian friends •> and in par-
ticular Santorini ; and which I have fpoken of, more than once, in the
fourth of the Adverlaria (/). Now take the whole of the obfervation.
44. A woman, who was fubject to hyfterical dilorders, and had a bad co-
lour in her face, being already the mother of fome children, and again in a
ftate of pregnancy j had an apprehenfion that the next birth would be fatal
to her.
And, at the time of her labour, (lie actually began to fwell in her fingers
and abdomen : and fbon after, having brought forth a girl inftead of a boy,
which fhe had hop'd for ; and by realbn of a kind of wager, (he would much
rather have prefer'd •, and this circumftance of the fex, though cautioufly
conceal'd from her by the women who attended, being imprudently reveal'd
to her by her hufband •, (lie was feiz'd with fuch an anxiety of mind, that her
pulfe immediately fank, and her body became cold.
It was then fcarcely an hour, from the time the girl had been born •, and
except fome part of the membranes, which the healthy and lively girl had
drawn with her, nothing of the fecundines had been difcharg'd : either be-
caufe the placenta adher'd very clofely, or becaufe the midwife had judg'd
that (he ought to wait for the afilftance of nature •, as (he remember'd that her
own grand-daughter had formerly difcharg'd the retain'd placenta, on the
tenth day after the delivery of the child.
As, therefore, neither pulfe, nor heat return'd •, within an hour and a half
from the time that they began to be deficient, death fucceeded : the flux of
blood from the uterus •, which you will be furpriz'd at in this defect of pulfe i
continuing in its ufual ftate till the very laft extremity of life.
We open'd the body at the twenty-fourth hour after death. From the
mouth, and noftrils, of the carcafe, a great quantity of ill-fmelling water was
difcharg'd. The tumour of the belly was fo great, that I do not remember
to have feen a larger, even in patients with an afcites.
And this tumour did not fubfide very much, when the peritonaeum was
open'd ; for it was then found to be chiefly owing to the ilomach, and in-
terlines, being diftended with air, in a furprizing manner •, and to the uterus
that lay beneath them, which not only occupied the whole pelvis by its ro-
tundity of bulk, but even exceeded that dimenfion.
Before we cut into the uterus, together with all the appendages connected
to it, we obferv'd a bloody water to be effus'd into the cavity of the abdomi-
nal pelvis. And we had before obferv'd the veflels, which are under the fkin
of the thighs, near to the pudendum, to be fill'd with blood : and the bones
of the pubes, where they are join'd to each other ; having been examin'd, be-
fore difie&ion, with the finger, and having feem'd to gape, or at leaft to be
very laxly join'd together ; had their commifiure fcarcely touch'd with the
knife, before they were feparated from each other ; fome fluid being, at the
fame time, difcharg'd.
And nearly the fame things appear'd to us foon after, when we examin'd
the juncture of the ilium with the facrum ; fo that we believ'd thofe not to
have been far wide of the truth, who have aflerted, that, not only in women
{/) Animadv. 26. 27. 39. 43. 45.
in
Letter XLV1II. Article 4.4. 74^
in their fir ft time of child-bearing, as Hippocrates has taught us (*), but
fometimes, alio, in a birth which is not very laborious, M the coxcndiccs are
" feparatcd."
Lifting up the uterus, after taking it out, \vc law that a very large inafs of
concreted blood was difcharg'd through the orifice of the vagina. Scarcely
any thing of the nymphz appear'd •, probably in confequence of th.eir having
given way, and been extenuated, in the birth, in order to prevent the neigh-
bouring Ikin from being lacerated -, lb that they would loon after appear in
their former fhape.
Thus our Fabriciusab Aquapendcnte'^); before he cut into the membrane
which (hut up the orifice of the vagina in a virgin, and was diftended with
a very great quantity of blood, which lay upon it ; remark'd that there was
no appearance of the nymphaj : yet thefe he prefently law form'd, when
the membrane was incis'd, and the tenfion taken off.
From hence ; if things are always in the fame Mate after delivery, as Dio-
nis (h) hints ; you may conjecture at one of the ufes of the nymphae.
While we were looking at the external parts, I Ihow'd to my friends, the
lacunx which I had fpoken of in the firft of the Adverlaria (i) in the for-
mer year •, preiTing out, at the fame time, a whitifn humour, and a confi-
derable quantity of it, wherewith, in this woman, they abounded.
Soon after I alfo obferv'd, and demonftrated, the lymphrcducts of the
uterus i as I likewile did the ftru&ure of the corpus luteum, in one of the
teftes.
But of thefe, and, in regard to the round ligaments of the uterus, how
great a thicknefs they had, on account of the veiTels, whereof they are in
great part made up, being diftended with blood •, and, in regard to the ute-
rus itfelf, of what fibres and finufies it confifted, and how large thefe were,
together with the external blood-veffels •, and alfo, of the largenefs of the
ofculum uteri, and of the dilatation of the cervix uteri, not being lels than
that of the fundus itfelf-, and finally, of the very frequent orifices in that
ofculum, and the mucous glands in the lower part of the cervix ; of all
thefe, I fay, I have already written what is fufRcient, in the fourth of the
Adverfana (k).
Now, if there be any thing v/hich had no place there, it muft be added,
that you may have the whole of the obfervation as I promis'd.
Both of the teftes had a kind of fmall foramen on the furface, through
which a (lender probe was admitted into the internal parts. And in than
fame teftis, wherein was the corpus luteum, was a roundifh bony cell ; and in
the cavity of it a bloody humour. The tubes were longer than they gene-
rally are.
The parietes of the vagina were extenuated, and itfelf was become much
wider than its natural dimenfions allow •, but not at all fhorter : fome rugse
only correfponding with the corpus glandofum urethras.
The ofculum uteri was of a red colour, degenerating into black ; and
(*) De Nat. Pueri n. 43. (b) L'Anat.del'Homme Detnonftr.4. fedt. 2.
(g) De Chir. Operat. ubi de Hymene Im- (/') Tab. 3.
perior. (k) Animadv. fupra ad n. 43. indicatis.
Vol. II. 5 C in
746 Book III. Of Difeafes of the Belly.
in fome places lacerated. Within the cervix were no little chords promi-
nent, nor fmall membranes.
It was evident that the placenta had adher'd to the upper part of the fun-
dus uteri, in fuch a manner, as to cover the orifices of both tubes. And
the fame adher'd in fome meafure even then. But where it had adher'd,
there the orifices of the uterus were extremely contracted •, where it did now
adhere, there they were large •, as was with great truth laid in thofe Adver-
faria, as the other circumftances were : which I here confirm for this reafon,
left, to thofe who have not yet happen'd to light on any fuch things, they
may feem to be paradoxes in a different fenfc from that in which the Greeks
had been us'd to underftand this word. In the finufles, with which thofe
orifices communicated, was no blood.
Finally, in the thorax ; for we never touch'd the head •, both lobes of
the lungs were univerfally of a white colour degenerating into livid, if you
except the pofterior parts where the blood had fubfided in the fupine pofture
of body. The heart was flaccid beyond defcription, and contain'd icarcely
any blood in the auricles and the right ventricle •, and in the left ventricle
none at all.
45. That a great quantity of blood had flow'd out from the uterus, by
reaibn of the placenta being- loofen'd in part, I would not deny ; but whe-
ther it was difcharg'd in fo great a quantity as to kill the woman, may per-
haps with reafon be doubted.
For, on inquiry from the women who were about her, we could not learn
that a very great quantity had been difcharg'd •, and fome of the veffels were
diftended with blood even after death, as I have told you above: fo far were
they from being " almoft void of blood," as the celebrated Tabarranus {I)
found them, in women who died of floodings, a few hours after delivery : then
the pulfe and the heat did not decreafe gradually before, but fuddenly, and
altogether, at that very inftant of time, when this difagreeable circumftance
was related to her; for nothing of this kind is proper to be told to women
in thefe circumftances, and leaft of all to thofe, who, being fubject to hyfteT
ric affections, have their nerves prone to convulfions; which, if they feize up-
on the noble vifcera, eafily deftroy the weaker and more delicate kind of wo-
men : and this you will find to have happen'd to a woman, who, being
fatigued by preceding labours, and wearied by a difficult birth, was, foon
after this, and at the very time (he was fpeaking, contrary, to all expectation,
fuddenly fe'rz'd with a convulfion and death; whereas the celebrated Jo.
Sebaft Albrechtus (m) could fufpect no other caufe for this change, but dif-.
agreeable news, which was heard by the patient at that time.
Nor did it feem to all thofe learned phyficians ; who not only heard, with
me, the relation I have given you, but were alfo prefent at the dilTedtion ;.
that the death of this woman had been owing to any other caufe.
But before you judge, I would have you attend to this circumftance alfo ;
I mean into how great a tumour, and that a flatulent one, the belly of the
woman had increas'd.
(/) Qbf. Anat. n. 36.
{m) Aft, n. c. torn. 4. cbf. 50.
And
Letter XLVIII. Article 45. 747
And yon have, even in this feci ion of the Sepulchretum ; tha: is in the
thirty-eighth •, fome ol- ns wherewith yon may compare this oi mine.
In the firft place the fifth, which, through careleflhefs, is repeated under
number thirteen, oft woman, who, having' died ten horn elivery, had
her whole belly tumid with flatus, is lomewhat li malar. But as it is laid iliac
her uterus was full of coagula, and many evacuations arc mention'd •, juft as
it is laid, by Euftachius (»), that in the Roman matron, in whom the proper
membrane of the kidnies was fo diftended with included flatus as at nrft to
have the appearance of a large tumour, a great quantity of blood was dif-
charg'd after delivery; at leali turn to the fourth, and ninth, of thole obser-
vations, that are added in the appendix.
Neither of thefe mention a haemorrhage; but both of them defcribe the
belly as having been diftended wirhin a very little time after death, with
flatus, above what can eafily be imagin'd.
Yet if you fay that thefe women died in labour, and not after they had
brought forth ; and that the firft or them had already carried a putrid foetus
in utero-, fee, I befeech you, how Hoffmann (0); notwithstanding he confi-
de rs too great effufions of blood, among the preceding caufes of inflations of
the abdomen, and that even in the time of child-bearing •, neverthelefs foon
after makes women fubjedt to the fame inflations from a contrary caufe : as,
for inftance, if the flux of the lochia has not fucceeded in a proper manner,
or has been altogether rcftrain'd. Which I only hint, that you may remem-
ber, how many caufes, and how different from each other, there may be of
this fame kind of tumour in the belly.
And whichsoever of thefe caufes it was produe'd by in our woman, you
will find, if you read the hiftory over again, that it was form'd before the
effufion of blood came on ; for the woman had begun to fwell in her abdo-
men, and her fingers, before fhe was deliver'd.
And in the cafe of that woman, of whom Phil. Jac. Hartmann (p) has
written, the inteftines were tumid with flatus, on the lad days before deli-
very •, and this tumour increas'd fo much after birth ; notwithstanding there
was no profluvium of blood, and even the lochia were obftructed ; that the
fuperior and inferior tracts of the interline colon, in particular, could fcarcely
be comprehended " in a thread that was three parts of an ell long:" the
lower part of it therefore, being feiz'd with a fphacelus, and ruptur'd, fill'd
the belly with the moil foetid fordes, and carried off the woman on the fecond
day after delivery : and to the uterus of this woman, '• the remains of the
*' placenta adher'd internally, to the whole furface ; and were eafily feparable
with the finger: but in the cervix itfelf " coagulated blood adher'd."
However, not to fpeak only of thole preternatural appearances, which oc-
cur'd in the body we have been fpeaking of; but even to touch, at the fame
time, upon others a little, which, that you might have the whole of the hiftory,
are not omitted here •, I could wifh that learned men had read, not in the
patch-work ot a mere compiler, who wanted many books that were neceffary
for his purpofe, but in Antonius Sidobre (q), all thole things which Chy-
rac had communicated to him, in regard to the la<5teal ducts of the uterus ;
(>i) Traft. de Renib. c. 45. (/>) Eph. n. c. dec. 3. a. 9 & 10. obf. ioz.
(<?) Medic. Rat. torn. 4. p. 4. c. 15. Thef. (q) Tract, de Variol. c. 7.
Patiiolog §.8 & 15.
5 C 2 for
748 Book III. Of Difeafes of the Belly.
for they certainly would not have fuppos'd that thefe were the " fame," as
thofe lymphasducls that I law in this woman.
I could wifh likewife, that thofe who have faid thefe were feen by Ruyfch,
and others, had exprefsly pointed out the paffage of that author, and the
year in which others law them ; as I did not fcruple to declare [r) at what
time I had feen them, and to whom 1 fhow'd them.
Who have feen them after me, I know ; amongft whom I would have you
obferve, that the learned Stehelinus (s] had alio feen them in a diftended ute-
rus : that is in the uterus " of a gravid woman."
But who have given figures of them, as appendages to the uterus of wo-
men, from the human fubject, and not from the anatomy of brutes ; I do
not as yet certainly know : fo that I am not furpriz'd, if, to that illuftrious
man Heilter (t), thefe veffels, I fay thefe veffels " as they are hitherto added
" to the human uterus in figures, fhould feem to be taken from fancy."
But in regard to the bones of the pubes, and the ileum ; I do not fuppofe
you are in the number of thofe who contend, that it very rarely happens in
child-bearing, for the commiffures, or junctures, of thefe bones, to be found
fo lax as they were feen by us in this cafe ; and that, when this does happen,
it is to be imputed rather to the ricketts, the lues venerea, or to a cachexy :
and this laft, in a very confiderable degree.
The woman, however, of whom we are fpeaking, although fhe had not
a good colour in her face-, yet certainly was neither affected with a cachexy,
particularly in any great degree, nor with any of thofe other dilbrders : nor
had a matron to whom I was related, labour'd, in the leaft, under any of
thefe complaints ; although, as fhe complain'd of a pain at the juncture of
the bones of the pubes, after her time of delivery, and her hufband would,
for that reafon, have me examine this part with my hand, fhe had one of the
bones manifeftly diftant from the other at that time-, but at other times
had not.
And notwithstanding almoft innumerable obfervations of this kind are
extant, which many have collected-, they have neverthc-lefs omitted fome, if
I rightly remember, and particularly one of Veflingius (u) : fince he, in a
woman in labour, " perceiv'd that the pelvis yielded, and fhook, with a
" flight impulfe ; the bones, both under the pubes, and at the fides of the
" os factum, being feparated from each other by the fpace of an inch at
" leaft:" and Santorini (x) found it eafy alfo, to lay his thumb betwixt the
bones of the pubes, in fome women who had been lately deliver'd : fince
therefore fo many obfervations are extant-, is it more proper to fuppofe, that,
in all of them, thofe diforders were to be accus'd, efpecially as the writers of
the obfervations make no mention of them ? Or muff, we fuppofe, that, as a
greater or lefs feparation, is not only not very rare, but frequent, it is not
preternatural ? And even, that, in thofe where it does happen, it happens
from nature itfelf -, for it comes on by degrees, is by degrees remov'd, and
is of affiftance to the birth, as far as it is poffible for it to contribute thereto.
(r) Advcrf. Anat. IV. Animad. 43. in fine. («) Epift. 2^.
(x) Teirtam. Med. p. 1. Thef. 6. \x) Ob£ Anat c. n. §. 4.
(/) Coinp. Ana.1 n. 236.
For
Letter XLVIII. Article 46. 749
For do not imagine, that whatever enlarges the diameters of the pelvis, is
ufelefs in the promotion or" delivery •, and as to what is laid of the dimenfions
of the pelvis •, as if they were fufficient to admit of the paflage of the foetus,
without any leparation of the bones ; it feems to have been taken from the
flccleton, when no mention is made of luch a number of parts, that are inter-
pos'd betwixt the naked bones and the head of the infant, that is paffing
through them •, and indeed, nothing of the uterus ; the orifice of which is
then pufh'd down to the orifice of the vagina : which parts, though they may
not iufficienrly diminifh thole dimenfions in many-, yet in many, on the other
hand, may diminifh them very much.
And that thefe junctures are gradually difpos'd to laxity ; as I have hinted
in the Adverfaria (y), in conjunction with Pinseus -, I have not only had oc-
cafion of knowing by examining the juncture of the offa pubis with my fin-
ger, but during the revifal of this letter, have feen confirm'd by diffection,
by the celebrated Exup. Jofephus Bertinius (z) ; and by the example of two
women, the one pregnant with a foetus of five months, and the other with a
foetus of feven months : for the cartilage betwixt the offa pubis was not only
found to be " thicker than ufual, and impregnated with an unctuous hu-
" mour" in both of them, but particularly in the fecond ; in whom even
" without a knife," and only by a flight affiftance of the hand, one of the
offa ilii " was pull'd afunder," perfectly, from the os facrum.
And if authors of weight and eminence had attended to this itate, in the
junctures of the bones of the pelvis ; which is begun in gravid women, in-
creas'd at the time of child-birth, and confequently often obferv'd in women
after delivery •, they would not, in my opinion, eafily have objected to thofe
who fuppofe i'uch a fcparation, " that they cannot be broken afunder by the
" butchers but with difficulty :" or that two ftrong men, pulling one on each
fide, were not " able to draw afunder" the bones of the pubes.
Nor indeed is that to be wonder'd at •, for they were not previoufly dif-
pos'd, as in women after child-birth. And indeed I commend the ingenuity
of thofe, who, in dependance on a great number of arguments, have oppos'd
the opinion of thefe feparations as " impolTible."
But it is to very little purpofe, to endeavour to prove that to be impof-
fible, by reafonings, which has been fo many times feen : for it is eafy to any
one to let afide fuch reafonings-, as it is more than fufficient immediately to>
refute them by the undoubted teftimonies, of all thofe who have feen the cir-
cumftance, and demonftrated it to thofe who were prefent.
46. But women after delivery are not only carried off by diforders that are
quick in their progrefs ; as that of which I fpoke lafb, or that which we read
of in Henricus Sandenius (a), from the thicknefs of the uterus being in-
creas'd to half a fpan, or rather from that which is not a very rare, but even
a frequent caufe; I mean a fphacelus of the uterus, which you will fee de-
fcrib'd in one, and another woman, by the celebrated Jofeph Henry Fuch-
Xius (b) ; I fay, women after delivery are not only carried off by diforders
that are quick in their progrefs, but by flow diforders likewife : for they are
(y) III. Animad. 15. fa) Obferv. de Prolapf. Uter. §. 14. in
(zj Qua'ft. de hoc aigura. propofita pnefide fine.
Bouvart. n. £. (/') Aft. n. c. torn. 2. obf. 146.
feme-
75° Book III. Of Difeafes of the Belly.
fometimes in an ill ftate of health along time alter delivery, and even as long
as they live.
In what manner a flow fever, from an abfeefs of the teftis and tube, carried
off a woman after delivery, I have already fa;d in a former letter (c); and I
have (hewn, at the fame time, Low it fometimes happens, that from a iabo-
rius utero gtftation, and a diffixv Lt time of child-bearing, theic parts contract
great injury.
And that at the fame time of pregnancy, the omentum, being comprefs'd
by the uterus, and theothei vilcera^ and for that reafon fometimes inflam'd •,
may be form'd into an oblong and airnoft fcirrhous tumour, which remains
in fome after delivery •, as has even been obferv'd by me •, and affects them
fometimes with pain, but always with iome inconvenience or other; Ruyfch
(d) has taught us, and before him Bauhin (e) hinted, when he afferted, " that
" the omentum remains collected about the middle of the belly, after de-
" livery, in fome women ; fo as to excite confiderable pains ; which how-
ever, as I have already laid, are not perpetual fymptoms.
And thele pains were the molt fevere, and obftinate, after delivery, in
that woman, who having been afflicted with them a long time, and at length
carried off thereby (f), had the omentum contracted into the form of a
rope.
But it had grown to the bladder, and fundus uteri, in fuch a manner, that
with the pains were join'd thofe fymptoms, which made her appear to fome
to be hytterical ; and to others to be troubled with calculi.
Add to this other diforders that are not painful, but very troublefome ;
which remain after a rather unhappy time ot child-bearing-, lamenels, pro-
lapfus uteri, and incontinence of urine, which have been fpoken of in iormer
letters •, and have been partly fpoken of in this (g).
Finally ; for it is not my intention to enumerate every thing that relates
to this queftion ; " the haemorrhoids in the orifice of the matrix ;" that is at
the orifice of the vagina ; mention'd by Cellus formerly (b), and by the
author of the book which they formerly attiibuted to Galen; that is the
book de Gyneceis ; Arantius has, with great reafon and juftice, anerted, '; ge-
" nerally, to have their origin from a difficult birth," in that chapter (;)
which he has written upon the ill effects of thofe haemorrhoids, their caufes,
figns, and cure.
And Paul Barbette (k) has added, by what marks the blood flowing from
them, may be known from menftruous blood.
47. Laft of all, the caufe of unfucccfsful births is not to be confider'd as
exifting in the mother only, but alfo in the foetus that is brought forth ;
whether this is born dead, which circumftance I have fpoken of before, or
moreover whether it be born in a monftrous ftate befides being dead; or,
finally, whether it be living indeed, but is born in a monftrous ftate, or
affected with fome other confiderable diforder.
(<r) EpiJl. 46. n. 27 & 28.
(^) Cent. obf. Anat. Chir. 63.
(e) Theatr. Anat. 1. 1. c. 12.
(/) Eph. n. c. dec. 3. a. 4. obf. 7.
U) N. 53-
(b) De Medic. 1.6. c. iS. n. 9.
ft) 56. in 1. de Tumor, p. n.
(k) Anat. Pratt. 1. 4. ad fin.
Firft
Letter XLV1II. Article 48. 751
Firft then, in regard to monfters, whether bom alive or dead ; but what I
1 lay here, will be rather what relates to the oblervations themfelves, than
to the contTOVerfy which is agitated in this ape, among very learned men, in
regard to the origin of thefe monfters : and I Hull begin with this obfervation
or Valfalva.
4S. The mother of a monfter, which, as appeal 'd to the common people,
was like a toad, had often brought forth children before, both of the male
and female fpecies promilcuoufly •, the former being all of" them found in
every refpect, but the latter, which were two, one of whom was then in her
thirteenth year, and the other fome years younger, both deaf, and confe-
quenrly dumb.
At laft, having conceiv'd about eight months before •, and having lain,
during the whole time of this pregnancy, always fad and melancholy, and
accuftom'd herfelf to weep often by reafon of this (late of mind; and when
fhe compar'd the motion of this foetus with that of the others, which (be had
brought forth before, finding it fo languid that fhe fometimes almoft bcliev'd it
dead •, fhe brought forth, at the time I have mention'd, a female foetus, which
was furnilh'd with fecundir.es indeed, that were in a natural ftate, but was fo
monttrous in its afpect, that it feem'd rather like a toad, than a girl-, if you
except the lower limbs, and the inferior part of the belly.
In the firft place, it was fmall, fo as not to equal a fpan in length •, but
•was fo much fhorter than this, as to be deficient, in that extent, by the
breadth of a man's thumb.
In the fecond place, the neck was entirely wanting ; fo that the chin was
contiguous to the middle of the bread, and even was fcarcely diftant by the
extent of an inch, from the cartilago enfiformis.
The eyes indeed were perfect; .but the external ears were plac'd much
lower than they generally are, and touch'd the upper parts of the moulders :
the mouth was gaping : the nofe was imperfect at the upper part ; for the
root of it, and the forehead, were entirely deficient.
Add to thefe horrid appearances, that the abdomen protuberated in the
manner of a kind of purfe hanging downwards ; into the middle of which
purfe the funiculus umbilicalis was inferted, and was in its natural ftate.
Finally, the upper limbs were fo connected to the fternum, that they could
not be extended. A.nd on the pofterior furface of the body, the fpine ap-
pear'd to be diftinguifh'd into three gibbofities as 'it were; the upper of
which correfponded to the head, the middle to the thorax, and the lower to
the belly.
Thefe were the appearances externally.
And by the diffedtion of the belly, it was found that the purfe, into which
the abdomen protuberated, was owing not only to the relaxation of the inte-
guments of the belly, but alfo to the mufcles thereof; and that in this re-
lax'd cavity, as in a kind of fac, the liver, the fpleen, the ftomach, and all
the inteftines were contain'd : yet thefe vifcera, as well as thole that were
contain'd in the thorax, were, in other refpecls, in a natural ftate.
When we came to the head, a confus'd heap offer'd itfelf to our view.
Eor there were neither the bones that are wont to form the roof of the cra-
nium, nor indeed could we find any cavity of the cranium ; but there were
only/
752 Book III. Of Difeafcs of the Belly.
only bones of an irregular figure, fome fmall, and fome a little larger, con-
nected to each other by an intricate net-work of mufcles.
Not the lea(t traces of the brain were found, except that certain bodies
nppear'd, which had a very fine reiemblance to the nates and teftcs of the
cerebrum ; but only in their figure ; for externally they were every where
made firm with membranous connexions, and internally were not, by any
means, fimiiar to the fubltanteof the cerebrum •, but rather to a certain body
of a middle nature betwixt glandular and fpongy.
And even if the brain had not been deficient, and this girl could have
liv'd j yet fhe mirft have been deaf as well as her fillers : becaufe both the
foramina, through which the nerves are fent from the brain to the ears, were
Unit up with a very firm membrane -, fo that no paffage was left even for the
mod (lender nervous filament.
Nor indeed could we find the medulla fpinalis any more than the brain,
nor any beginning from whence the nerves took their origin ; notwithstand-
ing they were carried through the belly, the thorax, and the limbs, natu-
rally enough in other refpedts.
For in tracing even the largeft nerves ; as, for inftance, the crural ; when
you came near to the fpine, you faw that they gradually became more {len-
der, and were fix'd into the fpine indeed •, but in the whole courfe of this
fpine there was not only no medulla fpinalis, but even no cavity for the me-
dulla fpinalis to be comprehended in.
49. Although Valfalva has omitted to fay whether this foetus was born dead
or alive •, and likewife, in what ftate the kidnies, the bladder, the uterus, and the
nerves that run through the head were-, yet he has written what is fufficient to
make us very clearly understand, that the principal diforder of the fame foetus,
relates to the clafs of thofe which I treated of in my twelfth letter to you (I) •,
when I affirm'd that the cranium was frequently in great part, and the brain
wholly, confum'd by a hydrocephalus, in foetulTes of this kind (which are in-
deed not uncommonly confider'd as toads (m) ;) and gave you examples of
thofe («), in which not only the medulla fpinalis could not be found, but
what is much more rare, the tube, wherein it is naturally contain'd, was
entirely deficient.
And I did not relate this hiftory of Valfalva's among the others in that let-
ter, as, befides thofe particulars, it contains others ; whether you confider
the chin, or the fpine, or the upper limbs, or in fine the abdomen, and the
greater part of the vifcera of this cavity ; on account of which I thought it
rather more proper to put it off till the prefent occafion.
To which I mould certainly have defer'd, for fimiiar reafons, if I had then
had them, the obfervation of Baronius, which will be fubjoin'd a little be-
low (0), and perhaps another of mine, which is the third of the girls I dif-
fered wherein the brain is deficient ; for all of them, as well as this of
Valfalva, and that of Baroni, were of foetulTes of the female fex : which you
will add to what I obferv'd, in a tranfitory manner, in that letter (p).
(!) N. 5. & feq. (») Epift. 12. n. 8.
(«) Vide Haller deFoetu Hum. fine cerebro (0) N. 52.
not. 2. (j>) N. 6.
I
But
Letter XL VIII. Article 50. 753
But now take this third obfervation of mine : a fimilar one to which, es-
pecially on account of the fpine being bifid at the lame time, was made
two years after at Copenhagen (q).
50. A monller •, for fo it was call'd •, which had been born two or three
days before in this place, was fhown to me by a furgeon in the month of
February, of the year 1746.
Upon feeing it, I immediately faid that it was without any brain. To
confirm therefore what I laid by difiection, I defir'd it might be brought to
my houfe ; where he inform'd me, that the woman, having been the happy
mother of many children before, had likewife had a very happy time of
pregnancy with this laft.
But that when fhe thought herfelf come to the end, or near to the end, of
her pregnancy •, me had not got rid of this dead girl, but by a very ifficult
birth, that was quite unexpected ; the foetus being at length taken away, by
the midwife, by the feet.
Yet in effect, I found it to be confiderably lefs than a full grown foetus
mould be : for it was not equal to the length of a foetus of feven months ;
and Valfalva, as I have already faid (r), found his likewife to be very fmall : and
this, if we conceive the head to have been previoufly diftended, and enlarged,
by the included water, may be underftood pretty eafily •, as I have written to
you on a former occafion (s).
However, this little body would have been fair, beautiful, and well fed, hav-
ing no ill fmell, and the cuticle having not yet abfeeded ; as it was very well
form'd in the reft of its parts •, if thefe deformities had not been added, that
there appear'd to be no neck : and above the eyes there was fcarce any fore-
head. And from that place, inftead of the common integuments of the
body, was one reddifh membrane : and this going over the upper part of the
head ; which was not at all protuberant in that part, and even had a decli-
vity on the pofterior parts-, pafs'd through the middle of the back to almoft
the lower part of the thorax ; being the lefs broad in proportion as it de-
scended the more.
Under this pofterior part of the membrane, rofe up two bony protube-
rances, as they feem'd to be ; one of which proceeding from each fide of
the head, and being lefs elevated in proportion as they receded therefrom,
and more near to each other, fhow'd that a bifid fpine was beneath the in-
teguments.
At the fides of this membrane the common integuments were not defi-
cient : and with thefe the lower part of the head, as well as all the reft of
the body, was cover'd on both fides ; being not only furnifh'd with external
ears, in that part, which were contiguous to the moulders, but alfo with
hair ; as if that part of the cutis, which lay neareft, being pull'd away from
the upper part and lacerated, that part of the hairy fcalp which remain'd,
had contracted itfelf downwards to this place.
Thefe were the appearances externally.
(?) Vid. Rob. Steph. H«nrici Defcript. (r) N. 48.
Omenti not. ad §. 11. (s) Epift. iz. n. 7.
Vol. II. /; D And
754 Book III. Of Difeafes of the Belly.
And upon cutting into the abdomen, a great quantity of fat firft came into*
fight-, a great quantity of which was everywhere under the fkin, likewife,
wherever there was a fkin : and when the remaining parietcs of the belly
were open'd, all the vifcera appear'd to be in a natural ftate, as thofe of
the thorax did alfo.
At length coming to the head, under that red membrane (which was thin)
when cut through, there appear'd nothing which I could poflibly confider as
the remains of the cerebrum, cerebellum, or medulla oblongata, except two
little horns as it were, which being thick, foft, and of a red colour, but de-
generating into brown, were prominent in the anterior fides of the cranium,
one in each •, for when cut into, they fhow'd, befides concreted blood, a
kind of mucous matter.
Under thefe horn-like prominences, was that part of the os frontis, which
makes the pofterior roof of the orbit. For the anterior roof was wanting-,
the bones of the finciput were wanting ; and all the part of the occipitis,
that is not before the foramen magnum of this bone, which for that reafon
was none at all in this cafe, was wanting.
Bones of the temples there in fact were -, but thefe were extended down-
wards, laterally, and backwards. And at the foramina of thefe bones, which
the auditory nerves enter, I in vain fought for the beginnings of thefe
nerves -, as I did likewife for the others in this bafis of the cranium.
And this made me be the lefs furpriz'd, when I examin'd the eyes foon af-
ter -, which as well as the eye-brows were well form'd -, to find the optic
nerves more (lender than ufual, and terminating to appearance within the
orbits.
I then faw that the tongue was very long, but not equally wide in propor-
tion to its length. And this correfponded to the lower jaw, which was of
fuch a length, as to to extend itfelf beyond the upper anteriorly ; though the
upper was here greatly flretch'd out forwards, as it defcended : and yet the
rio-ht, and left, parts of the lower jaw, were at a greater diflance from each
other, the more they receded from the chin -, as they naturally are.
"Wherefore the interval betwixt the two, was longer indeed than ufual,
but much more narrow -, and was moreover ftill render'd narrower, by a pe-
culiar thicknefs in both of them. And at the lower part of the chin, both of
them had coalefc'd into one bone -, without any line being interpos'd, as ge-
nerally happens in children.
And now to fpeak of the fpine ; all the vertebra of the neck were not
really wanting, but only three : yet the reft were fo crowded upon each
other, that certain parts of fome of them were concreted into one fubftance
with the contiguous parts of the next. And the fame was feen in the two
or three uppermoft vertebra; of the thorax -3 the very bodies of which were
even join'd into one fubftance.
From thefe the fpine began to proceed backwards, and at the fame time to
be curv'd towards the left fide : which incurvation, when it had reach'd al-
raoft to the vertebras of the loins, was chang'd into a contrary direction ; and
thus was continued even through the os facrum.
But the firft incurvation was much more considerable than the fecond:
wherefore the latter only lifted up the left os ilium a little > but the former
rais'd
Letter XLVHI. Article 51, 52. 755
rats'd up the right fcapula confiderably, and made the whole feries of the
ribs (land out differently in that fide, from what they did in the oppofuc
fide.
And there were on the right fide eleven ribs only •, whereas on the left
there were twelve, yet the thoracic vertebras were in all only eleven, and the
lumbar fix.
But what was more worthy of remark, the fpine was really bifid. For the
upper vertebra of the neck, and all the others after that •, if you except thofe
that are below the la It but one of the loins ; had all that bony matter, which
is added to their bodies, in order to form a tube for the fpinal marrow,
collected on both fides, and expanded, in order to compofe thofe two protu-
berances externally, of which I fpoke above. Wherefore, as in the cele-
brated obfervation of Littre (t), there was no tube, and no fpinal marrow in
this fubject.
If at any time you come to Padua, you fhall fee the whole fkeleton curi-
oufly prepar'd by our Mediavia ; whereby every thing that I have defcrib'd
in the bones, is clearly fhown.
But it would have been much more beautiful to look at, if the bones
could all have been brought to that whitenefs, which they have in the fkele-
tons of other fcetuffes, that I have by me in great number. Yet, although
the bones are hard, and no care was omitted to procure this whitenefs ;
•what I did not think ought to be omitted in compleating this obfervation •, a
certain brown and blackifh colour could not be entirely remov'd from fome
of the bones in particular : and efpecially from molt of the longer bones in
the limbs.
And in regard to thefe longer bones, I think it ought not to be conceal'd,
that they were of lefs thicknefs than they generally are in fcetuffes of a height
equal to this •, but of greater length.
51. In the fame year 1746, when I happen'd to pafs the month of Sep-
tember in my native place, Philip Baroni ; the great grandfon of him who
wrote upon the pleuropneumonia, formerly my agreeable auditor, and at
that time a very experiene'd phyfician among his native Meldulenfes, who
loft him by an untimely death •, fent to me an obfervation, together with
figures, which he had made about that time ; and which is fimilar to that
propos'd juft now (u) from Valfalva ; and therefore will not be omitted in
this place.
52. A monflrous girl was brought forth in the beginning of the fixth
month after conception, by a woman who was in the thirty-fixth year of her
age •, but of a bad colour, thin, and much extenuated from great labours,
which fhe had undergone beyond her flrength ; and from bad food.
And befides that fhe herfelf had very infirm health, fhe was likewife mar-
ried to a man who was notrobuft, but even of a dull and heavy nature ; and
fhe afferted, that, in the months preceding this abortion, fhe had been ter-
rified in her dreams, by a face.very much like that which the girl had.
For, beyond the eye-brows there was no forehead or head : the nofe was
deprefs'd, the mouth gaping, the external ears contiguous to the fhoulders •,
(t) Mem. de l'Acad. R. des Sc. a. 1701. (u) N. 48.
5 D 2 and
756 Book III. Of Difeafes of the Belly.
and that on the right fide was very much inclin'd downwards : there was no
neck, and no chin : for the face below the ears and the mouth, terminated
immediately in the bread ; fo that, as it was deficient in its fuperior part, it
was alio deficient in its inferior part.
The mufcles of the abdomen, and the common integuments of the body,
that lay upon them, did not invert the much greatell part of the anrenors of
te ely-, but a membrane that was lax, and extended into the form of a
very large purfe, cover'd this part: and into this membrane thofe mufcles,
and integuments, being gradually extenuated, feem'd at length to dege-
nerate.
Within this membrane, which was pellucid by reafon of its thinnefs, the
liver and inteftines were feen to be hanging; outwards.
The thumb was wanting on the right fide: and this hand was fo bent up-
wards, that betwixt that and the arm was comprehended almoft a regular
angle. Thefe were the appearances anteriorly.
On the back part, you might fee the regio dorfalis cover'd with hairs : and
at the upper part of this region, in the middle place betwixt the fcapulas,
was a large and deep chink gaping like another mouth ; which was form'd
by the vertebrae being open in that part.
And not much above this chink, arofe from the occiput, by a broad bafis,
a kind of flat mufcle, which being unconnected with other parts, if it were
extended forwards, cover'd the eyes, and the nofe, in part : but if it were
carried to the pofterior parts, cover'd the back quite to the loins.
And this mufcle was fimilar to the tongue of an adult man, both in figure,
and magnitude. From which you may eafily conceive how fmall this girl was.
Although fome things are wanting in this defcription, and thofe in parti-
cular which ought to have been inquir'd into by difTection •, if that had been
permitted •, yet from the defect of the forehead, and the remaining part of
the fornix of the cranium ; as I gather from the adjoin'd figures •, and in
like manner from the foramen, or rather if you pleafe from the chink, which
was form'd by the gaping of the upper vertebrae ; I feem to myfelf to be
fufficiently clear, that in this foetus, as well as in that of Forli (x), with
which you will compare the prefent obfervation, the cerebrum was wanting.
And indeed I had an opportunity of examining, but not of difiecting, a
foetus, at Padua, in the year 1735, whofe hiftory, which I then collected
with accuracy, I will fubjoin here ; not only for feveral reafons relating to
the mother herfelf, but alfo becaufe in that which relates to the abdomen
at leaft, and could be feen without difTection, it comes very near to thofe of
Valfalva, and Baroni.
53. A matron of one and forty years of age, yet in pretty good health,
and the mother of many children at leaft ; whom fhe had brought forth very
happily, and all of them very well form'd •> brought forth a monftrous
infant
This woman had had no appearance of her menftrua in the October laft
pad, nor in the months after that, to the twenty-firft day of June : the
(x) Vid. Epift. Anat. 20. n. 56. Sc feq.
belly,
Letter XLVIII. Article 53. 7 57
belly, and the breads, fwell'd in their proper time ; together with a good
colour of the face, there had been a pretty good ilate of health.
Yet fhe did not think herfelf pregnant, becaufe many fymptoms of her
former pregnancies were wanting ; in particular the tumour of the belly in
fo great a degree as it us'd to be before ; and the motion of the infant, which
had hitherto been very great and continual, but was now none at all. To
theie circumftances was added, that, in the laft months a hard and circum-
fcrib'd tumour, like a diftended bladder, was perceiv'd, for the mod part, in
the hypogaftrium : but foon after leem'd to vanifh away fuddenly.
This then being the date of the cafe •, and, in the laft week before the day
juft now mention'd, a frequent and unufual neceffity of making water, and a
fenfe of weight about the pudenda coming on •, and her breads decreafing in
their tumour three days before ; and finally, on the day before, a few drops
of a brown and thick humour, and in the morning of the following day, the
fame quantity of bloody matter, having diftill'd from the genitals •, labour
pains came on after dinner: and fhe brought forth with very great eai'e,
and without the aflidance of any midwife, the membrane amnios in an entire
ftate ; for the chorion was turn'd upwards; with the annex'd placenta.
As fhe had us'd to be troubled with very long-continued pains for the
moll part, and with a (low and difficult exclufion of the placenta, fhe was
fo much the more furpriz'd at this new and very great facility ; becaufe,
though fhe had been accuftom'd to difcharge a great quantity of blood, both
at the time of menftruation and delivery, but a little was difcharg'd at pre-
fent ; and but little on the following days likewife, except one.
And to finifh the whole hiftory of the mother ; fhe rofe up to her ufual
domeftic employments, not on the thirtieth day, as at other times, but on
the third, or fourth; and even foon after went from home: nor was this
Gondudl of any injury to a woman who was in other refpecls not very robuft.:
nay fhe was even as well as fhe had ever been, became impregnated after-
wards, and brought forth a living and well-form'd child.
But, en the other hand, let me tell you how deform'd her prefent off-
fpring was.
The fecundines, as far as I could judge, did not differ from the ufual ap-
pearance of nature ; except that the placenta ieem'd to be fomewhat fmall,
in proportion to that bulk, of the entire amnios, which was defcrib'd to me :
for it was of the diameter of three inches and a half. In the amnios was a
yellowifh and turbid water, but not foetid ; and the dead infant feem'd, to
me, not to be lefs long than thofe generally are, that are brought forth be-
twixt the fifth and fixth month.
The face of it was very long, and therein a flefhy globe, in appearance, was
prominent from the middle of the lower part of the forehead. Under this
lay the eyes contiguous to each other; for there was no nofe ; not cover'd
with eye-lids, but with a tranfparent membrane through which they were
feen.
The mouth was in its proper place ; but gap'd fo as to fhow the incifor
teeth. The abdomen was open in the middle; and the intedines were pufh'd
out from thence. The common integuments of the body were alfo open at
the loins ; out the hiatus did not defcend much lower.
4 All:
7 5 8 Book III. Of Difeafes of the Belly.
All the limbs were in a very bad date : the upper limbs from the elbows
downwards •, for to the arms, which were very fhort and diftorted, diftorted
hands were like-wife added. And the inferior limbs terminated likewife in
diftorted feet : but the left leg was either broken, from the funiculus umbi-
licalis having been wrap'd very clofely round it ; or was more diftorted than
the other parts.
54. "What if the mother had been prefent at fome horrible fpectacle, or
had feen fomething of the like kind in a picture ; or, at leaft, like the wo-
man fpoken of above (y), had dream'd of luch an appearance ?
But this mother denied that fhe had ever feen any thing of the kind, or
had even ever thought of it, waking or afleep •, or that any confiderable force
had been applied to her belly, during the pregnancy, either by falling, or
conftringing, or compreffing it ; or, finally, by fhaking it violently : for we
have an example of this caufe alfo in a very violent convulfive cough (2) :
this only fhe confefs'd, that during the whole of this pregnancy, fhe had
been very gloomy and down-caft in her mind; fo that if we compare the gef-
•tations of thefe four monftrous foetufles, and that alio of Forli (a) one with
another, it is wonderful, that the geftation of that which we defcrib'd in the
fecond place (b), was fo happy.
But as to what I faid juit now, as if in oppofition to the powers of the
mother's imagination; I would have you underftand it as coming from a
man, who is by no means diipos'd, immediately to account for every mon-
ftrous appearance in fcetufTes, from this power.
For many relations are extant of diforders of this kind, and particularly
of that we are fpeaking of; and not only in the collections of patch- work
compilers, but even in the writings of illuftrious men, who have firft pub-
lifh'd an example of thefe diforders ; or fome one of that kind ; as feen by
themfelves, and others (c). 1
But if you examine the greater part of thole authors, from whom thefe
examples are produc'd, you will fee how readily they are accounted for from
the imagination of pregnant women-, and that when even they could be very
fairly deduc'd from fome external violence, a part is neverthelefs affign'd to
the imagination likewife.
Though I cannot approve thefe things ; yet, on the other hand, there are
cafes wherein it feems to me to be very hard to depart from that opinion,
which is common to the greateft men, totally and altogether. What Boer-
haave (d), what Van Swieten (?), what other grave authors of undoubted
credit affert to have been feen by them that relates to this queftion, no one
will doubt the truth of.
fWN.52.
(z) Commerc. Litter, a. 1735. hebd. 9.
n. 2.
(a) Vid. n. 52. ad finem.
(b) N. 50.
(c) Vid. Sachs Eph. n. c. dec. 1. a. 1.
Schol. ad obf. 135. Schroeck. dec. ead. a. 6
& 7. obf. 232 : Goth. Ben. Preuff. in Append,
ad earund. cent. 7 & 8. Ritter. Act. n. c. torn. 8.
obf. 88 : Stalpart. cent. 2. p. 1. Schol ad obf.
36 : aliofque ; fed prs ceteris Haller, not. c c.
& feq. ad Praelett. Boerhaav. §. 694. & Opufc.
Anat. VI. §. 16. not. III. Sc feq. & Opufc. IX.
not. 2. & feq. ad §. 3.
(<1) Prsleft. adlnftit. ?. 69+.
(e) Comment, in Boerhaav. Aph. §. 1075.
ad 2.
If
Letter XLVIII. Article 54. 759
IF any one contends that each of them might be produe'd, at other times,
from fome internal diforder ; I fhall not greatly conteft it with him. But that
they were, at that time, produe'd from the lame place, 1 cannot readily
allow.
A mulberry falls upon the globular part of the nofe of a pregnant wo--
man ; and this woman brings forth an infant, on the globular part of whofc
nofe a mulberry protuberates -, " perfectly exprefs'd " in its magnitude, co1-
lour, its roundifh prominences, its roughnefs, and its very fmall hairs.
A caterpillar falls from a tree upon the neck, of another woman, and can-
not be taken away but with difficulty ; and a girl is born, on the fkin of
whofe neck, the form of a caterpillar is prominent •, being of various colours,
and having upright hairs ; and, in a word, being fo fimilar to a true cater-
pillar, that even " no egg could be more like another."
Another woman fees a beggar that has a hair-lip, is terrified at it, and
brings forth a child that has its lips deform'd with fiflures, of the fame kind
that were feen in the beggar ; and even perfectly fimilar as to their dimen-
iions (f).
Another (g) heard of a little girl, whofe right hand was entirely without
fingers; the thumb only being in its proper place, and the places of the
fingers being occupied by nails prefix'd to the metacarpus : thefe things fhe
thought of in herfelf *' very much, and for a long time ;" and fhe at length
brought forth a foetus whofe right hand was juft in the fame figure.
Nor mud we conceal the cafe of her (£), who brought forth a boy without
a cranium •, the place of the brain being occupied by a kind of red flefhy
mafs ; and who, having underftood that two children were taken out of the
water, in which they had been drown'd, without any fkull, and without any
brain, had excruciated herfelf " with that fix'd and obftinate imagination,
*' and with a perpetual rumination on the part evil :" nor ought (he to be
forgotten who (/'), having brought forth a girl affected with the hydro-rachitis
in the loins, " and having the fame idea continually, and repeatedly, reviv'd.
*' in her imagination ;*' at the next time of child-bearing brought forth an-
other girl; " disfigur'd with the fame kind of deformity as the firft, and ex*
" actly in the fame place."
Finally ; to omit other obfervations which might be produe'd, and fome
which I very well know in confequence of having feen them, and to fpeak
of one which in fome meafure relates to the three that I laft defcrib'd to
you ; there was a woman (k) who brought forth a foetus which had its hands
and feet incurvated upwards, and was deform'd with two tumours in parti-
cular, the one at the os facrum, and the other under the navel, where the
inteftines, and the other vifcera, coming out through the hiatus of the ab-
domen, greatly rais'd up the peritoneum, in which alone they were con-
tain'd.
As the midwife was prudently determin'd neither to fhow, nor defcribe,
to the mother a birth of this kind ; the woman herfelf of her own accord de-
fcrib'd it, faying, that fhe, in the middle of her pregnancy, had dream'd of
(f) Vid. aft. n c. torn. 6. obf. io. (/) Salzmann. diflert. de quibufdam tumor.
{g\ Commerc. Litter, a. 1632. hebd. 20. tunic, ext. §. 3.
(/;) Eph. n. c. dec. 3. a. 9. & 10. obf. 106. (k) Schol. ad PreufT. obf. cit.
an
760 Book III. Of Difeafes of the Belly.
an infant rufhing violently againft her belly, which had its limbs incurvated in
this manner, and was deform'd with two tumours •, one anterior and onepof-
terior-, in the fame manner as her foetus really was: wherefore, waking out
of her fleep in a fright, fhe had ever after retain'd the melancholy idea of
her dream.
You will perhaps then fay, if you deny that this can be afcrib'd to the
imagination of the mother ; tell me, I beg of you, by what means thefe ap-
pearances can be produe'd.
But there would be too many things in phyfics that I mud deny, if they
were to be denied, becaufe I do not underftand the manner in which they are
brought about.
And certainly, even you ; if you are willing to confefs the truth, according
to your cuftom ; do not fufficiently underftand, how it has happen'd, that,
after thofe particular imaginations, a difeafe was at hand which deform'd the
foetus, in the fame manner as the imagination had fuppos'd ; fo that the
mulberry we have fpoken of, the caterpillar, the fillures of the lips, the mu-
tilation of the fingers, and the unufual fituation of the nails, that defect of
the cranium and cerebrum, that diforder of the fpine, that incurvation, and
-thofe tumours, not only anfwer'd perfectly to the imagination in their figure,
and other conditions •, but they even exifted in the globular part of the nofe,
on the neck, on the right hand, on the lips, in the head, in the loins, in the
limbs, on the pofterior and anterior furface of the body, in fuch a manner as
the foregoing imagination requir'd.
Perhaps you will fay this happen'd by accident. And I mail readily afient
to you where a certain imagination has not preceded •, and the diforder does
not correfpond fo exactly, both in figure and circumflances.
But where this has preceded, and the diforder correfponds thereto, in the
manner I have faid ; not even you yourfelf, if you confider all things ac-
curately, can entirely acquiefce in the accufation of chance •, efpecially, if
you have an eye not only to one example, but to a great number, as there
are: for you will not eafily fuppofe that chance could have been ib ingenious,
if I may be allow'd to fpeak thus, and fo' exact an imitator.
What is then the cafe ? In refpect to myfelf, in many, and even in very
many, inftances, I fhall readily accuie chance if you pleafe ; but in fome of
the examples I mail rather accufe fomething elle, which I confefs I do not
underftand.
Now to return to the foetus which I laft defcrib'd ; the death of it was
brought on either by the circulation of the blood being impeded through the
funiculus umbilicalis itfelf •, in confequence of its being bound clofely round
the leg ; or by fome very bad conformation of the internal parts, like that of
the external ; which naturally depriv'd it of the power of growing, and mov-
ing itfelf.
And the exit of the inteftines from the abdomen ; the blame of which is
often thrown upon the rough and violent handling, and prefiure of the mid-
wives, when they deliver the infants ; in this cafe, where there could be no-
thing of that kind, certainly muft be attributed to the abdomen itfelf of the
foetus never having been (hut up ; or at leaft not fufficiently fhut up.
For
Letter XLVIIf. Article 55. 761
For from the original formation ; as Harvey (/) has alio i'aen in the embryos
of perfect animals, as they call them, and as I have certainly feen in thofe of
dogs ; it is open.
And afterwards, unlefs the peritoneum, the mufcles, and the common in-
teguments firmly and clofely (hut it up, it muft, without doubt, cither re-
main open, as many have found it, and among thefe formerly, more than
once, Bofcus (m)'(whom I do not remember ever to have feen quoted in col-
lections of obfervations of this kind) ; or muft be relax'd into a purfe of the
fame kind with that feen by Valfalva (»), and Baroni (o) : and if the covering
is very thin and (lender, it may cafily be broken through by the very weight
of the vilcera.
For when it is made up of the peritonaeum only, it is fo thin, as even to
fuffer the periftaltic motion of the interlines to be feen through it; as Ruyfch
(p), who has three obfervations relating to diforders of this kind (q)y has af-
ferted.
In reading of which obfervations attentively, and comparing them one with
another, and with thofe which he gave afterwards, in his anfwer to Bidloo
(?) ; where he contends that thefe obfervations are rare ; you will perhaps
wifh he had not previoufly faid, without any kind of repugnance, that this
diforder had been feen by him " many times," and " frequently."
But left you mould fay, that all the obfervations of monftrous foetuffes
whatever, which I have produe'd above, relate to the defect of parts, I will
add fome which fhow an increas'd number of fome parts ; and that either
with a defect of others, or without a defect of any.
One that was formerly fent to me by that very eminent phyfician, while
living, Sebaftian Trombelli, which defcribes, befide that diforder of the abdo-
men, of which I fpoke juft now, a great part of one infant growing to ano-
ther; and that not only externally, but mix'd internally in their fubftances ;
I fhould very gladly have produe'd here, if 1 had not given it to our Vallifneri,
by whom it was publifh'd, in the latter end of his elaborate volume on ge-
neration (j). 1 will give you another however, in which my friend Mediavia
obferv'd both the diforders in fome meafure.
55. An infant was born at Padua, about the beginning of July, in the year
1736, of a mother who had before brought forth other healthy and living
children, and brought forth others afterwards.
This child, if you look'd at it, had one diforder, which was a tumour equal
to the fize of a man's fill:, in that part of the abdominal region, on the right
fide, which is call'd umbilical, and a little above the navel itfelf.
The tumour was destitute of fkin, which, being elevated round about
into a kind of border, terminated in a little prominence : Bofcus (/), who
had taken it into his head to fuppofe that this was caus'd by an ulcer, would
have call'd it a cicatrix ; as you alio may call it, where you fuppofe the hiatus
of the abdomen, to have been produe'd by fome violence ; and the parts in
(I) De genem. animal, exerc. 69. (j) Ibid. obf. 71. & 72.
(m) De Facult. anat. led. 1. in fine. (r) Refponf. ad Bid!, vind.
(n) Supra, n. 48. (/) P. 3. c. 5. & tab. 3. 4 & 5.
(0) N. 52. \t) Left.. 1. Paulo ante cit.
(p) Cent, obf anat. chir. 73.
Vol. II. c. E which
762 Book III. Of Difeafcs of the Belly.
which the hiatus is produc'd, to be retracted on one fide and on the other ;
and explain the cafe nearly in the lame manner as the celebrated Preuflius (a)
explains it.
The tumour was unequal, and yielded to the touch •, fo that it fcem'd to
be made up of the interlines. The infant at firft neither difcharg'd any thine-
from the inteftines, nor fuck'd the bread. Yet foon after it began to do both.
But what it difcharg'd from the interlines was green : and the clothes were
thereby ftain'd with fpots, which could not be walh'd out but with great diffi-
culty j "and indeed, frequently not at all. And the tumour which had been
fomewhat livid before, began in the mean time to be more livid, and at length
to be feiz'd with a gangrene. Part of the rectimufcles, that lay under the
fkin, abfeeeding, together with the furface of the tumour, the infant died on
the five and thirtieth day after its birth.
The diffection of the belly fhow'd that this child had a double liver ; one
of them being in the ufual fituation, and rather fmall, though divided into-
very long lobes ; the other larger, but fhapelefs : and this being join'd with
the former, by the interpofition of a thick membrane ; annex'd to the trunk
of the vena portarum, but fending its veins into the cava, below that other
liver ; extended itfelf to fuch a degree, as to force the peritoneum, which
adhcr'd to it, and the tendons added thereto, outwards, and make up the
tumour of which I have been fpeaking.
And this tumour yielded to the touch, from the yielding of the inteftines ;
upon which this liver in part lay. But although there was a double liver, no
gall-bladder appear'd any where. However the fmall interlines were in a na-
tural ftate ; but the colon was very much contracted.
56. Shall we fuppofe, that as two fpleens are fometimes found in one body •,
and that even not very feldom •, for I have feen it three times (x) ; fo alfo two
livers were given to this one infant ? Or mud we fuppofe the larger -liver,
which was prominent outwards, to have belong'd to another foetus, the other
parts of whom had perifh'd in the uterus ?
For in that double-bodied foetus which Zambeccari had difiecled, and Val-
lifneri has produc'd fjy), the livers of both bodies feem to be join'd together
by a kind of thick membrane that was interpos'd (2).
But fhall we fuppofe it to have happen'd by mere accident, that the veins
of the praeternatural liver, fhould come into the fame trunks, into which the
veins from the liver proper to this infant open'd ?
Without doubt this difficulty, which is much greater in mod of the vifcera
of that double-bodied foetus, is one of thofe which have given rife to the
late controverfy upon the origin of monfters.
Nor were the fame circumftances wanting in a calf, which was with great
kindnefs fent to me, in the beginning of March in the year 1745, by that
very refpeclable and learned man Jo. Dominic Lavarini, counfellorat Verona.
In this calf I (hould probably have obferv'd many more things •, and fuch,
perhaps, as would be more worthy of being written to you ■, if it had not
been brought firft from th« mountains to Verona, and from thence to Padua j.
(a) In append, fupra ad n. 54. cit. (y) C. 5. ad n. 54. cit. 8c tab. 7. & feq.
{x) Epift. 37. n. 30; epift. 38. n. 34; & (2) Tab. 10. fig. 3 & 4.
epift. 64. n. 2.
2 after
Letter XLVIII. Article 57. 763
after it had been born dead, and had the belly open'd ; mod of the vifcera
being taken out in order to preferve it the longer : and not only this but the
diaphragm being cut into, and the pericardium laid open ; fo that, at fuch a
diftance of time, it was become lefs fit for difieflion and accurate obfervation.
Yet the few things I had it in my power to oblerve, I will fet down here.
$y. A two-headed calf, whofe heads and necks, if you compar'd them
one with another; and the remaining parts of the body, if you compar'd
them with other calves naturally born ; fliow'd fcarcely any difference, when
look'd upon externally, gave the following appearances after the thorax was
open'd and examin'd.
The fpines, as they came from two ne.cks, continued to be two in the
thorax likewife ; being disjoin'd by fome diftance : but this diftance decreas'd
fo much the more, in proportion as they defcended the lower ; lb that, at
length, below the thorax there were no longer two fpines but one only.
And the tranfverfe bones became fhorter in the fame order; and corre-
fponding to the ribs in thicknefs, in breadth, and in fituation, were each of
them plac'd in that interval of the fpines.
In the courfe of this interval pafs'd the defcending trunk of the great artery,
which was very large in confequence of being made up of two joining into
one, and did not fend off two intercoftal arteries only, but three and three
in order, as far as this interval continued : for one of thefe arteries went to
this interval itfelf.
Each fide of the thorax was occupied by two large lobes of lungs, of which
I have written to you on a former occafion (a) ; for each afpera arteria was
divided into double bronchia, defcending on each fide from their proper
neck.
There were two thymi alfo •, although at firft they feem'd to be join'd into
one. There was, however, but one pericardium, though in it two hearts,
quite disjoin'd from each other, were contain'd.
Thefe hearts were equal to each other in fize, and of the fame ftructure
both internally and externally: but they differ'd in thefe things ; firft, that
as one of them was very near to the fide of the other, the furface of the left,
which was contiguous to the right, was fo confiderably hollow'd out, as to
receive the natural convexity of the right, to which it perfectly correfponded :
and in the fecond place, that both of them did not turn the fame furface to
the fpine ; but the right that which it naturally ought : and the left had that
furface, which is ufually turn'd to the fpine, turn'd to the right heart : and
that was the furface which was hollow'd out in the manner I have faid.
And left you fhould fufpect this excavation to have been brought on by
the right heart ; which perhaps might have lain on the other for a long time
after death ; remember that this hollownefs was confiderable ; as has been
{aid •, and know that there was fuch a firmnefs, and thicknefs, in the parietes
of both hearts, in this calf; which was already at its full growth, and had
been perfect ly well-nourifh'd in the uterus ; that it is impoffible to account
ior that excavation from thence.
And if not only the hearts, but other parts alfo, had been very firm at that
rime ; and a molt putrid fmell had not been more and more troublefome ; not
(a) Epift. 19. n. 48.
5 E 2 only
764 Book III. Of Difeafes of the Belly.
only to me who differed, but even to thofe who were near me •, I mould
have gone on, with pleafure, ftill to inquire into other circuinftances of this
monilrous formation.
However, of all the vifcera which remained in the abdomen, I did not fee
that any was doubled contrary to the ufual courle of nature.
58. As the infelicity of birth, which is fcen in the oflf-fpring produe'd, does
not only happen when it is born in a monilrous ftate ; but alfo, as I have
laid down above (b), when it is affected with fome very confiderable dif-
order; I will alio hint a few things on the fubjecl: of this infelicity: I fay a
few things only •, not becaufe the dignity of the fubjecl, and even neceffity
itfelf, would not require more, but becaufe this letter has already run out
to a great length.
For there are few diforders of infants, which really fall under the notice
of the fenfes ; if you compare them with the very great number of internal dif-
orders : and thefe are they which deftroy a great part of the human race, foon
after they are born : and that fo much the more eafily, in proportion as all
the veffels and vifcera, by reafon of their tender and foft ftate, are lefs fit to
protect themfelves againft preternatural diftentions and attritions ; and ftill
lefs to correct the diforder of any other vifcus, or veflel, from whence thofe,
or any other injuries, are communicated to them.
And to thefe difadvantages another very confiderable one is added : I mean
that phyficians cannot receive narrations, or anfvvers, from infants ; fo as to make
them underftand, in what part of the body, and with what uneafinefs, they
are affected ; and confequently cannot know what kind of remedy it is ne-
cefiary to ufe, in order to afiwage, and diminifh, this uneafinefs at leaft, if it
cannot be cur'd. Wherefore, Ballonius in particular, who excell'd in hi3
profeffion, pitying the lots of infants-, and tender children, has, in more than
one place, admonifh'd us (V), that as we muft then deal with children, " as
" if with dumb patients" (who however, when adult, fignify many things by
nods and geftures) we ought to be the more diligent to obferve all the marks
of difeafes that we can in them, and to profecute them by the moft prudent
conjectures : and he has taught us, by his examples, both in the pleurify,
and the ftone of the kidnies, not only what figns he had obferv'd in living
children, but alfo what he had found by diffection in the bodies of thofe that
died of thefe diforders.
And I, in purfuance of his plan, have formerly recommended the fame
method in the idea of medical inftitutions ; that art, like a convenient and
friendly interpreter, may not be wanting to aflift thofe, to whom nature has-
denied the power of making known their own diforders.
And if thefe things are necefiary, even in thofe diforders of infants, which,
in confequence of being common to adults, have fymptoms that are well-
known to phyficians, how much more necefiary will they be, in thofe difeafes
that are peculiar to infants !
59. I call thofe difeafes of infants peculiar, which are from the peculiar in-
tention of nature, in them, being difturb'd -, as, for inftance, a change of the
(I) N. 47. 2. conftit. autumn, a. 1557. ad 8. & in annot. &
(<•) Vid. 1. 1. confil. 76. in fine, & epidem. 1. conftit. aeft. a. 1558. ante med.
circulation
Letter XLVJIf. Article 60. 765
circulation in the blood, from that which was requir'd in a foetus, into that
which is requir'd in a child that is born.
In the former, as you very well know, the blood was carried, from the
placenta, through the umbilical vein, into the vena portarum ; and from
thence part of the blood, through the canaliculus venol'us, into the vena
cava: and from this a part goes through the foramen, which they call ovale,
into the finus of the pulmonary vein •, and part into the right ventricle of the
heart ; and from this cavity a part through the pulmonary artery into the
lungs; and finally, a part thro' the tubulus arterioles into the great artery;
from the iliac brandies of which, a confiderable portion of the blood was car-
ried, through the umbilical arteries, into the placenta.
But thefe arteries, when the infant is already born, are tied up together
with the vein of that name, and cut off; lb that no blood can any longer be
carried into them, nor carried back therefrom.
And the canaliculis venofus, and the tubulus arteriofus, are afterwards, by
degrees, fhut up ; as the foramen ovale is alio at length, if not quite fhut
up, at leaft generally diminifh'd.
It therefore happens, that the blood does not pafs into the cava, from the
vena portarum, but by the hepatic roots of the cava : and as that which is
carried through the cava to the heart is thruft into the pulmonary artery ;
lb nothing can come from this tube into the great artery, which is not carried
through the pulmonary vein into the left ventricle of the heart.
Add to thefe, the other intentions of nature at this time, that are peculiar,
and neceffary, for all thofe changes ; as, for inftance, that the milk mufl be
fuck'd from the breads, fwallow'd, and prepar'd in the ftomach ; the dia-
phragm mufl: be alternately contracted and relax'd ; the lungs mud be open'd
and dilated ; the air muft be drawn in, and prefs'd out again ; and other
things of this kind mufl take place.
Then imagine, that if any one part of the body be lefs proper for thefe
new, and neceflary offices ; or give too great a refinance ; or caufe thofe paf-
fages which ought to be fhut up, to be fhut up much later than this new
mode of life requires : imagine, I fay, what mufl: be the confequence, and
you will readily conceive, how various, and manifold, the diforders may be
that are peculiar to new-born infants.
60. I will illuftrate thefe things, by the inftance of a difeale which falls un-
der the notice of the fenfes. Infants are fometimes born without a palate ; or
are born with a fiflure of the palate. Whether, in thefe cafes, friction, o?
deglutition, or both, are prevented, or made much more difficult, it ap-
pears, that, by this means, the mouth is made unfit, or at lead lefs fit, for
fucking.
But as the difeafe is not only evident, but external, art contrives a method,
either of preferving the infants for many days; or, where the diforder is lefs
confiderable, for many years, and to a long life.
You will read what has been deliver'd by thofe celebrated men, Maloet, and
Petit (d) : the former ot whom relates that a child, born without a palate,
had liv'd fifteen days, by putting milk into the mouth with a fpoon •, and the
{d) Hift. & Mem. de 1'Acad. R. des fc. a. 1735.
2 latter,
766 Book III. Of Difeafes of the Belly.
latter, that fome were preferv'd, who had been born wkhafiffurM palate, by a
goat giving it the teat of a dug half-full of milk ; by the thicknefs, length,
and fofenefs, of which, the fiffure of the palate, and the cavity of the noftrils,
were fhut up at the fame time : fo that it was neceffary to withdraw the teat
every now and then, to prevent refpiration being impeded.
And this was done in thofe, who could not have accuftom'd themfelve.s,
as many others that he faw could not, to thofe inconveniencies in fucking,
and lwallowing, which are the neceffary confequences of a fiffur'd palate.
And with this hope of accuftoming the child to bear thefe inconveniences,
or at lead preferving it the longer, I remember that, in a fimilar cafe of
an infant, born at Padua, I took care, in the mean time, to have nou ifhing
glyfters thrown up. Yet not only the difeafe is then manifeft, as I have faid,
but the caufe alfo.
And there is another diforder, that is manifeft; but the caufe is uncertain;
as, for inftance, when infants newly born are affected with a very confiderable
jaundice: for with a kind of flight jaundice, almoft all of them are attack'd,
a little after birth. And if the caufe of this flight jaundice were afcertain'd ;
there would be, in my opinion, for the moft part, fome hint to lead us to a
probable conjecture at leafb as to the caufe of that more violent diforder.
I have heard fome account for the more flight jaundice, from the mothers
milk, which is yellowifh after birth. And indeed I myfelf have fometimes
feen this fluid to be yellowifh at that time.
But fuppofing this to be the cafe even at all times -, yet how has it fome-
times happen'd, that I have feen thofe infants to be very yellow likewife, who
had fuck'd neither the milk of the mother, nor of any other woman, who has
been lately deliver'd ? Or how fhould it happen, that Sylvius (e) obferv'd
" many to have been born with a jaundice," and not only " to have had it
" appear upon them fome time after birth ?"
There are learned men alfo, who fuppofe all newly-born infants to become
icteric in confequence of a coagulum being made of the firft milk, which
grows acid in the ftomach •, whereby the duodenum is diftended foon after,
and the bile regurgitates into the liver; and the blood, in confequence of its
paffage this way, being ftop'd up : which caufes are diftinguifh'd from this
circumftance, that by a little rhubarb, or foap, this jaundice is gradually
carried off.
But in many of thofe, that are born with this diforder, it is very clear that
the milk had never been made acid in the ftomach : and in re1pe& to fifteen
children of my own, who all became yellow foon after birth, and fome of
them in a confiderable degree, the diforder was naturally carried off in every
one of them of itfelf, and without the leaft afTiftance of art.
But that, in all thefe, the milk, which fome had fuck'd from their mother,
and others from different nurfes, had grown acid is fcarcely to be fuppos'd :
and indeed in other infants indifcriminately, who fuck fo different a milk,
and have fo differently-conftituted a ftomach, we cannot reafonably fuppofe
this to happen.
Perhaps fome perfons would be ready to believe, that this new aliment
(e) Prax. med. 1. i.e. 46. n. 11.
carries
Letter XLVIII. Article 61. 767
carries more of the oily particles into the blood than the liver is equal to the
fccrction of 1 if they did not then fay, that the inteftinal foeces were white,
which is a very clear argument that the bile does not at all flow into the
interline duodenum.
Mow is it then ? If an effect, which is common to all, mult have a com
rr.oa caufe, it is not repugnant to probability ; that we ought to have our
eve to the vena umbilicalis, which; whether it be confider'd as cut afundci,
tied up with a thread, and Decefiariiy bringing on fome contraction in the
vena portarum into which it is continued ; or as depriv'd of the blood which
returns from the placenta, and not afiiiling, by this ufcful additamentum,
the other part which is carried through itfelf, and is perhaps thicken'd from
the new kind of aliment ; may, in either or both ways, retard the fecretion of
bile in the liver ; till this vifcus, upon the ceafing of that contraction, be-
comes, by degrees, accuftom'd to its new mode of action, and is again fit for
the feparation of the bile.
However thefe things, as you fee plainly, depend upon conjecture alone.
61. But there are other things which may be confirm'd by the difiection of
infants. I remember to have read, among the remarks made by Cowper,
in his Appendix to the Anatomy of the Human Body, that they in whom he
found the pafiages I have fpoken of above (f); that of the tubulus arteriofus,
and of the foramen ovale in particular ; to be (hut up too early in life, had
been frequently afflicted with a great number of diforders, fuch as inflamma-
tions of the head, neck and lungs.
Wherefore, when thefe diforders attack new-born infants without any pre-
vious manifefi: caufe, it will not be abfur'd and unreafonable to fufpect that
too hafty occlufion.
And as in this cafe he recommends a diminution of the blood •, fo you may,
at lead, recommend the giving of milk more fparingly, and prefcribe fuch
things to the nurfe, as will generate a more thin and fluxile milk,
O 7 o .....
For, by thefe means, the blood ; which is, in its whole quantity, carried
through the lungs, and rufhes into the fuperior branches of the great artery,
in fo much a greater quantity in proportion, as it is carried down in lefs
quantity into the defcending trunk thereof-, will pafs moreeafily, and will do
lefs hurt to the lungs, and the brain : from the injury of which perhaps,
as being at that time very foft, other diforders, befides thefe inflammations,
arife in the genus nervofum by which thofe new-born infants are frequently
and fuddenly deftroy'd ; and in particular thofe, in whom, befides thofe pre-
mature occlufions, there is already a more copious or denfe blood from the
uterus ; and the veffels of the brain are even much more infirm, than they
generally are.
And as fome may be born with fuch a vitiated ftructure, that thofe pafiages
of the blood, of which we have fpoken, may be (hut up too foon ; fo, on the
contrary, it is reafonable to fuppofe that fome are born, in whom there is an
oppofite diforder; and thofe pafiages, for that reafon, are not only never
wholly (hut up ; which has been met with by me and others frequently in
the foramen ovale ; but are not even diminifti'd : and this you may fuppofe
faid of the fame foramen ovale alio.
(f) N. 59,
And
768 Book III. Of Difeafes of the Belly.
And if fome bodies are, perhaps, fo form'd that they can bear thefe in-
conveniences without falling into dileafe, it is not, however, improbable, but
there are many more which cannot.
To this fubject relates a letter which was written to me on the eighteenth
of May, in the year 1722, by the celebrated Jano Planci. For he inquir'd
of me whether I had ever found the foramen ovale, in new-born infants, quite
unfurnifh'd with any valve.
The reafon of his inquiry was, that, in an infant lately directed, both he,
and a gentleman whom I have before fpoken in commendation of ; who then
liv'd at Rimini, and who was afterwards firft phyfician to the pope; I mean
Anthony Leprotti, had fought after this valve with accuracy, but in vain.
And the fummary of his whole obfervation, as far as I have collected it
from thefe, and the preceding letters of Planci, deferves well to have a place
in this epiftle.
62. An infant, who had not been born more than fifteen days, was carried
off from the ftate of the living ; but by what kind of diforder is not certain.
On examining the body, the ftomach was found full of good milk -, and this
vifcus, and all the others, appear'd to be found; except that the heart, and
the veffels which are about it, were diftended with blood in a furprizincr man-
ner.
Thofe parts of the umbilical veflels that are in the belly, and the tubulus
arteriofus, were open : and the foramen ovale was not only open, but was
entirely without its valve ; fo that not the leaft traces, or remains, of it ap-
pear'd, with whatever diligence you fought after it.
63. And as I wrote back to Planci, that this appearance was entirely pre-
ternatural, he naturally fell into that way of thinking, which I juft now fpoke
of. And ycu certainly perceive, that where that part which the blood urges
on the left fide-, and itr.pells, if not to fhut up the foramen ovale more and
more, at leaft to cover it in fome meafure •, is wanting, that certain motion of
the blood, which is requir'd in breathing animals, muft be perverted in the
principal organ : and if this perverfion, or perturbation, be not diminifh'd,
but continue to be (till the fame, the motion of the heart, and blood, muft,
at length, be quite fuffocated.
64. You fee, how very wide, and, at the fame time, an almoft unbeaten
track, lies open to inveftigate the difeafes of new-born infants, I mean by an
attentive and accurate obfervation in diffection after death, as well as while
they are living, if the foolifh love of parents did not withftand.
Yet thefe very parents, having loft all their infants, one after another, in
the fame manner, at length offer to the phyficians, of their own accord,
what they had denied before ; in order to try if it be poffible to preierve thofe
that may be born hereafter.
However, they frequently light on thofe who are either unfkill'd in ana-
tomy, or defpiiers of it •, both of which inftances I formerly faw in one and
the fame cafe. They who diffecxed the new-born infants, leported as their
fatal difeafe, that appearance which is, in them, quite natural •, I mean the
dura mater adhering very clofely to the cranium. They who were confulted,
fhow'd how much they had flighted anatomy, by admitting of this report,
and
Letter > LVIII. Article 65. 769
and confklcr'mg that very adhefion as the foundation of what they were to
tnfwer.
Yet if a diligent ftudy of anatomy brought with it no utility befides this;
that from the interna! conftitotion of bodies, which arc m a natural hate, we
might learn what things are mural and what preternatural', in inquiring after
the can lis of dilcalcs ; it certainly ought to be highly elteem'd, in Head or
being defpis'd.
But the bodies of tender infants have many peculiarities, befides thofe
which I have taken notice of above : lb that whoever would wifli to enquire
into their latent difeafes, to detect thofe appearances that are really morbid,
and compare them with the fymptoms which he oblerv'd in the children while
living ; and after that, according to the nature, and degree, of both, bring
lbme alleviation if not a cure, or, if it is imp.fiible to do this, at leaft to make
a prediction, andconfiim it by an explanation agreeable to what anatomy
may teach him, ought to be exercis'd in directions of thefe bodies.
Of a prediction thus explain'd ; not to digrefs far from the cranium which
we have .'.'ready mention'd ; there is an example in a fatal fign, which is, in
other relpecls, not unknown, in the writings of Wepfer (g).
For, when the death of infants is at hand, I have not only feen evident,
and profound, fulci, about the lambdoidal and fagittal future--, but alio a
fubfiding little pit near to the conjunction of the coronary and fagittal futures.
Why fo? Becaufe the brain is then collaps'd into itfelf; and by fubfiding
draws inwards, by means of the connections of the dura mater, whatever of a
membranous nature ftill remains in the interitices of the futures ; and con-
iequently produces thofe furrows, and this pit, or cavity.
65. But it will be proper, before any diligent man attempts thefe things in
new-born infants, to collect all the more accurate obfervations, and difTections,
that have been made by phyficians, and anatomitls, upon infants mere ad-
vane'd, and upon children ; for they are not extant even in the Sepulchretum,
unlefs in a fcatter'd ftate •, and out of thefe, to attend principally to tho'fe
which relate to the ltructures proper to that age ; or to the remains of thofe
ftructures, which particularly occur in new-born infants, and are fometimes
larger than is commonly fuppos'd.
Then let him afterwards add the obfervations which relate to thefe new-
born infants, as many as ever he can collect of himfelf, or obtain from
others fimilar to his own •, and let him make one body of them all ; which
fhould begin with the infants that are the moft advane'd, and end with thofe
that are lately born : for the former may, fometimes, by their imperfect
words, or their little hands, make fome difcoveries, which (if you remark
with what other fymptoms, that naturally offer themfelves, they are join'd)
will frequently amlt your conjectures, at the time when you happen to find
thefe other fymptoms, in thofe who have it not in their power to convey any
meaning by their tongues, or by their geftures.
I confefs I had a great defire ro undertake this part of medical knowledge •,
but the power was wanting. For although I might have been at liberty to
(g) Exercit. de loc. aff. in apopl.
Vol. II. 5 F obferve
770 Book III. Of Difeafes of the Belly.
obferve fick infants with fomc accuracy when living, yet it would not have
been in my power to have 'difiected them after death. And the former, with-
out the latter, would avail little to the purpofe.
You will therefore expect thefe things from others : and from me you may
ftill expect other letters, in relation to thofe difeafes, where I had not
only an opportunity of obferving in the living fubjects, but of difiecting
them after death. In the mean while farewell.
END of BOOK III.
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